Osteomalacia vs. Osteoporosis

Updated: June 26, 2023

Reviewed By:
Dr. Loren Fishman – AlgaeCal Scientific Advisory Board Member
MD, B.Phil.,(oxon.)
Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.

Most people are aware of osteoporosis; however, its sister bone disease, osteomalacia, gets much less press. 

There are some distinct differences between these two conditions, although both lead to the same result – weak bones that are prone to break. 

In this article, we’ll explore what osteomalacia is, why it happens, and the differences between osteomalacia and osteoporosis.

What Is Osteomalacia?

Osteomalacia (which means “soft bones”) is a condition that impairs your bone’s ability to mineralize, and therefore harden properly.

To understand the pathology of osteomalacia, we first need to look at two primary components of your bone:

  1. The bone matrix (made up primarily of collagen)
  2. Minerals (deposited in the bone matrix, creating strength and integrity)

Your bones are constantly going through a process known as bone remodeling, where old bone is broken down, and new bone grows in its place. Osteoclasts are a type of bone cell that helps to break down bone, while osteoblasts work to remineralize the bone matrix. This process keeps your bones healthy and strong, and when interfered with, it can create issues such as osteoporosis and osteomalacia.

In the case of osteomalacia, a lack of vitamin D results in demineralization of the bone matrix.

Here’s why: Vitamin D is essential for calcium absorption in the body, so low vitamin D means reduced intestinal absorption of calcium. Our bodies must tightly regulate blood calcium to support vital functions (such as generating a heartbeat), so when your blood calcium levels drop too low (in this case, from low intestinal absorption), your body looks for backup in your bones[1]. 

As a result, the composition of your bone shifts and becomes more collagenous and less mineralized, making them weak and quite literally “softer.” This interferes with bone remodeling, as bones with osteomalacia tend to break down faster than they can rebuild. 

In children, vitamin D deficiency causes a similar issue called “rickets,” where tissue near the ends of long bones becomes weakened, which can lead to bone deformities. Luckily, we rarely see rickets anymore since the fortification of milk back in the 1930s[2].

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Osteomalacia vs. Osteoporosis

The primary difference between osteomalacia and osteoporosis comes down to how they impact bone structure. 

In osteomalacia, lack of mineralization causes the composition of bone to shift more heavily toward collagen instead of a balance between collagen and minerals. Collagen is much softer than minerals, which ultimately means that your bones become soft and more prone to break. 

In osteoporosis, your bone mineral density decreases over time, making the honeycomb-like structure of your bones more fragile. This can create weak, brittle bones that are also more prone to fracture. 

Now let’s dive in a bit deeper to parse out these two conditions.

Difference between osteoporosis vs osteomalacia

Osteomalacia Causes

The most common cause of osteomalacia is a vitamin D deficiency. Vitamin D is essential for calcium absorption, so when this nutrient is deficient, calcium deficiency often follows. 

Vitamin D deficiency can result from several factors, including:

  • Diet: While there are some food sources of vitamin D such as eggs, fish, and fortified milk and juices, it’s still a challenge to get enough. 
  • Lack of sunlight: A much more efficient way for your body to synthesize vitamin D is actually through sunlight; the problem is that in our modern society, we typically don’t get enough of it. While our ancestors would have been outside all day, with moments in the shade here and there, today most people work indoors and avoid too much sun exposure due to inclement weather. Many people also avoid the sun due to the risk of melanoma[3]. 
  • Liver or kidney disease: Both of these conditions may inhibit the proper absorption of vitamin D[4]. 
  • Absorption problems: Gastrointestinal disorders like Crohn’s disease, celiac disease, and IBD can make it more challenging to absorb vitamin D through the diet.
  • Certain medications: Some pharmaceutical medications may inhibit the absorption or production of vitamin D.

Osteomalacia may also be caused by mineral deficiencies, specifically calcium and phosphorus, but this is much less common.

osteomalacia in leg

Osteoporosis Causes

The most common cause of osteoporosis is the combination of aging along with hormonal changes. As a young person, up until the age of about 30, you create more bone than you lose in the bone remodeling process.

However, once you get into your late 30s, bone breakdown begins to outpace the regrowth process[5]. This is typically not an issue for people in their 30s or 40s, but once you hit your 50s, another factor comes into play – hormones. 

Women are particularly susceptible to osteoporosis due to the sharp decline in estrogen that happens with menopause. Estrogen is a vital hormone for regulating calcium and directly influences the bone remodeling process. Therefore, when estrogen levels start to plummet, bone health can take a hit[6][7][8].

Declining testosterone in men also impacts bone health. This is typically more gradual than estrogen in women but can be affected by medications and lifestyle factors[9]

Furthermore, some existing conditions that impair proper nutrient utilization may also interfere with the bone remodeling process, such as digestive dysfunction (IBD, celiac, Crohn’s), issues with the thyroid or parathyroid gland, and certain medications[10][11][12]. 

And of course, nutrition always plays a crucial role in bone health. Your diet is the primary source of the building blocks that your body needs in order to make bone. If you aren’t getting enough nutrients such as calcium and vitamin D through your diet or supplement regimen it will increase your risk of osteoporosis[13][14].

nutrition for osteomalacia and osteoporosis

Osteomalacia Symptoms

Osteomalacia can present with a range of symptoms that indicate that your bone health is deteriorating. Common symptoms include[15]:

  • Muscle weakness
  • Difficulty walking
  • Pain in the bones, especially around the hips, back, and legs
  • Fractured bones due to minimal trauma

Osteoporosis Symptoms

Osteoporosis is called the silent disease because it may not present with symptoms at first as this condition typically evolves slowly over time. In fact, most people don’t even realize they have osteoporosis until they experience their first fracture. With that being said, there are some signs to watch out for, including[16]: 

  • Postural changes (hunched posture, bending forward)
  • Losing height (getting shorter by an inch or more)
  • Shortness of breath and pain with coughing (due to smaller lung capacity)
  • Pain in the lower back

Osteomalacia Treatments

Since the root cause of osteomalacia is usually low vitamin D, the most effective treatment is getting your vitamin D levels back up. This can be accomplished through more direct sunlight, consuming more vitamin-D-rich foods, or, most commonly, taking a vitamin D supplement. 

If the osteomalacia results from a mineral deficiency such as calcium or phosphorus, then you would likely be advised to supplement with minerals. 

In most cases, supplementing with both minerals and vitamin D is a good measure to take to provide your body with everything it needs to turn things around.

happy couple hiking

Osteoporosis Treatments

The osteoporosis treatment plan depends largely on your bone mineral density scan results. However, no matter what stage you’re in, you’ll likely be directed towards supplements that include vitamin D, calcium, and other bone-building nutrients. 

Furthermore, physical activity, especially weight-bearing exercise, helps to promote bone strength.  Amazingly, muscles communicate with bones through over 600 different molecular connections. This is known as “muscle-bone crosstalk.” Yoga, in particular, is a fantastic option for people with osteoporosis because while it’s gentle on the joints, it also generates forces up to 10 times greater than gravity.

Many people that are diagnosed with osteoporosis find the combination of supplements plus more physical activity do the trick in turning bone health around.

In some cases, your doctor might recommend medications specific to your condition. With that being said, supplements that include bone-building nutrients are helpful at any stage of osteoporosis.

Summary: Osteomalacia Vs. Osteoporosis

Osteomalacia Osteoporosis
Causes  The most common cause of osteomalacia is vitamin D deficiency, however other mineral deficiencies may also contribute. 
Aging is the most common risk factor for osteoporosis, coupled with hormonal changes and nutrient deficiencies which impact bone health.
SymptomsThe most common symptoms of osteomalacia include:

– Muscle weakness
– Difficulty walking
– Pain in the bones, especially around the hips, back, and legs
– Fractured bones due to minimal trauma
Osteoporosis is known as the “silent disease” because most people don’t even know they have it until they have their first fracture. 

Some signs to watch for are postural changes, losing height, lower back pain, and shortness of breath.
Treatments
Since vitamin D deficiency is most frequently the driving factor behind osteomalacia, increasing vitamin D is often enough to turn things around. This can be accomplished by taking vitamin D supplements, increasing vitamin D in the diet, and getting more natural sunlight.

You may also want to increase your intake of calcium and phosphorus as these two minerals play a crucial role in bone health.
The treatment plan for osteoporosis depends on the results of your bone density scan.

Both physical activity and nutrients that support bone health (like vitamin D, calcium, and magnesium) can help to rebuild and strengthen bone.

In the later stages of the disease you may be directed towards certain medications.

Takeaway

Although osteoporosis and osteomalacia present differently, they both can stem from nutrient deficiencies and result in bone fractures. 

As we get on in the years, it becomes increasingly crucial that we maintain our lifestyle habits such as staying active and getting bone-building nutrients into our diet. 

Bone disease can sneak up on you, so be sure that you’re talking with your doctor about bone health exams. 

Sign up for the AlgaeCal Newsletter for more tips and tricks to help you age gracefully and healthily.

FAQs

What is the difference between osteomalacia and osteoporosis?

The primary difference between osteomalacia and osteoporosis is how they impact bone structure. In osteomalacia, lack of mineralization causes the composition of bone to shift more heavily toward collagen instead of a balance between collagen and minerals. In osteoporosis, your bone mineral density decreases over time, making the honeycomb-like structure of your bones more fragile.

How are osteomalacia and osteoporosis similar?

Both osteomalacia and osteoporosis involve structural changes to your bones, making them weak and more prone to fracture.

What is the main cause of osteomalacia?

Lack of vitamin D is the primary cause of osteomalacia. When vitamin D is low, your body doesn’t absorb calcium well, which means that your bones become depleted of calcium. As a result, the composition of your bone shifts and becomes more collagenous and less mineralized.

What are the symptoms of osteomalacia?

Common symptoms of osteomalacia include muscle weakness, difficulty walking, pain in the bones (particularly around the hips, back, and legs), and easily fractured bones.

References

  1. https://www.ncbi.nlm.nih.gov/books/NBK551616/
  2. Walker, Alfredo, Dina El Demellawy, and Jorge Davila. “Rickets: historical, epidemiological, pathophysiological, and pathological perspectives.” Academic forensic pathology 7.2 (2017): 240-262.
  3. Wacker, Matthias, and Michael F. Holick. “Sunlight and Vitamin D: A global perspective for health.” Dermato-endocrinology 5.1 (2013): 51-108.
  4. Arteh, Jihad, Srilakshmi Narra, and Satheesh Nair. “Prevalence of vitamin D deficiency in chronic liver disease.” Digestive diseases and sciences 55.9 (2010): 2624-2628.
  5. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
  6. Ji, Meng-Xia, and Qi Yu. “Primary osteoporosis in postmenopausal women.” Chronic diseases and translational medicine 1.01 (2015): 9-13.
  7. McIlroy, Janet, et al. “Lesson of the week Oestrogen and calcium homeostasis in women with hypoparathyroidism.” BMJ 319.7219 (1999): 1252-1253.
  8. Khosla, Sundeep, Merry Jo Oursler, and David G. Monroe. “Estrogen and the skeleton.” Trends in Endocrinology & Metabolism 23.11 (2012): 576-581.
  9. https://www.spine-health.com/conditions/osteoporosis/testosterone-deficiency-and-osteoporosis
  10. https://www.endocrineweb.com/conditions/parathyroid/osteoporosis-parathyroid-disease
  11. Katz, Seymour, and Stuart Weinerman. “Osteoporosis and gastrointestinal disease.” Gastroenterology & hepatology 6.8 (2010): 506.
  12. Delitala, Alessandro P., Angelo Scuteri, and Carlo Doria. “Thyroid hormone diseases and osteoporosis.” Journal of clinical medicine 9.4 (2020): 1034.
  13. Kim, Kyoung Min, et al. “Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008–2010).” The Journal of Clinical Endocrinology & Metabolism 99.7 (2014): 2409-2417.
  14. Sunyecz, John A. “The use of calcium and vitamin D in the management of osteoporosis.” Therapeutics and clinical risk management 4.4 (2008): 827.
  15. https://my.clevelandclinic.org/health/diseases/13017-osteomalacia
  16. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis 

Article Sources

  1. https://www.ncbi.nlm.nih.gov/books/NBK551616/
  2. Walker, Alfredo, Dina El Demellawy, and Jorge Davila. “Rickets: historical, epidemiological, pathophysiological, and pathological perspectives.” Academic forensic pathology 7.2 (2017): 240-262.
  3. Wacker, Matthias, and Michael F. Holick. “Sunlight and Vitamin D: A global perspective for health.” Dermato-endocrinology 5.1 (2013): 51-108.
  4. Arteh, Jihad, Srilakshmi Narra, and Satheesh Nair. “Prevalence of vitamin D deficiency in chronic liver disease.” Digestive diseases and sciences 55.9 (2010): 2624-2628.
  5. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
  6. Ji, Meng-Xia, and Qi Yu. “Primary osteoporosis in postmenopausal women.” Chronic diseases and translational medicine 1.01 (2015): 9-13.
  7. McIlroy, Janet, et al. “Lesson of the week Oestrogen and calcium homeostasis in women with hypoparathyroidism.” BMJ 319.7219 (1999): 1252-1253.
  8. Khosla, Sundeep, Merry Jo Oursler, and David G. Monroe. “Estrogen and the skeleton.” Trends in Endocrinology & Metabolism 23.11 (2012): 576-581.
  9. https://www.spine-health.com/conditions/osteoporosis/testosterone-deficiency-and-osteoporosis
  10. https://www.endocrineweb.com/conditions/parathyroid/osteoporosis-parathyroid-disease
  11. Katz, Seymour, and Stuart Weinerman. “Osteoporosis and gastrointestinal disease.” Gastroenterology & hepatology 6.8 (2010): 506.
  12. Delitala, Alessandro P., Angelo Scuteri, and Carlo Doria. “Thyroid hormone diseases and osteoporosis.” Journal of clinical medicine 9.4 (2020): 1034.
  13. Kim, Kyoung Min, et al. “Interactions between dietary calcium intake and bone mineral density or bone geometry in a low calcium intake population (KNHANES IV 2008–2010).” The Journal of Clinical Endocrinology & Metabolism 99.7 (2014): 2409-2417.
  14. Sunyecz, John A. “The use of calcium and vitamin D in the management of osteoporosis.” Therapeutics and clinical risk management 4.4 (2008): 827.
  15. https://my.clevelandclinic.org/health/diseases/13017-osteomalacia
  16. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis

Article Comments

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  1. Merilyn Green

    April 18, 2023 , 11:33 pm

    Thank you very much for this article. it agrees with things that I have read elsewhere, but puts it together so it’s clearer to understand. It was very helpful.

  2. Manja

    April 19, 2023 , 7:36 am

    Hi Merilyn!

    Thank you for taking the time to comment. We’re happy to hear you found our article helpful.

    – Manja @ AlgaeCal

  3. Lori Lee

    April 19, 2023 , 7:10 am

    “In the later stages of the disease you may be directed towards certain medications.”
    What exactly is considered later stages?

  4. Gloria Asselin

    April 19, 2023 , 6:50 pm

    Thank you for the great advise, it was very interesting. I.ve seen you advise on Facebook about your session. I try to get your newsletter on Algae but my pc didn,t get it. I have Osteoporosis and Osteopia as well. Only because I had a sick husband that I took care of for one yr. and I didn,t take care of myself and went down hill, I was under stress as my husband had demenia and then he past away lasy June, therefore I need help in regaining my health. I had read about Algae Cal and I,m thinking of looking into the more imformation about this to see if it would help me. Thank you for your article.

  5. Megan Khera

    April 20, 2023 , 9:47 am

    Hi Gloria,

    Thank you so much for taking the time to reach out to us. Gosh, we are so sorry to hear about the passing of your husband and that your health recently went down hill. We want you to know that we are here to support you in any way we can. Occasionally our emails are sorted into a junk/spam folder by accident. If this isn’t the case, please give us a call at 1-800-820-0184 (USA & Canada toll-free) and we’ll look into this with you.

    – Megan @ AlgaeCal

  6. Gloriette Reiner

    April 20, 2023 , 5:26 am

    Thank you for this important information.

  7. Megan Khera

    April 20, 2023 , 9:58 am

    Hi Gloriette,

    Thank you so much for commenting! We’re glad you found this information to be helpful!

    – Megan @ AlgaeCal

  8. Viviana Fontana

    April 20, 2023 , 10:29 am

    What do you mean when you say “In the later stages of the disease you may be directed towards certain medications” – I’ve always believed that taking the AlgaeCal + strontium and Omega supplements was enough to improve without having to take bisphosphonates. When you talk about certain medications do you mean bisphosphonates? Thank you!

  9. Megan Khera

    April 20, 2023 , 12:12 pm

    Hi Viviana!

    Thank you so much for taking the time to comment! To clarify, in later stages of bone loss is when you might be directed towards certain medications by your health care practitioner, whereas in earlier stages this is not quite as typical. Rest assured, AlgaeCal is clinically supported to increase bone density, no matter how much has been lost. It is fantastic to hear that you are taking our Bone Builder Pack and Triple Power Fish Oil to support your bone health. Should you have any questions, don’t hesitate!

    – Megan @ AlgaeCal

  10. Debbie Santa

    April 20, 2023 , 10:44 am

    I have been taking Algae Cal for over three years now and I also do exercises I feel my bones are strong but I also feel I need to be careful and continue taking Algae Cal with vitamin D added. Thank you, Algae Cal you saved my life and you saved my bones..

  11. Megan Khera

    April 20, 2023 , 12:13 pm

    Hi Debbie!

    Feedback like this makes our day! This is wonderful to read.

    – Megan @ AlgaeCal

  12. Mahin

    April 20, 2023 , 1:50 pm

    Thanks for sending such a informative article

  13. Megan Khera

    April 20, 2023 , 2:12 pm

    Hi Mahin,

    Thank you so much for commenting! We’re glad you found this information to be helpful!

    – Megan @ AlgaeCal

  14. Fatima Delmar Dukes

    April 20, 2023 , 6:07 pm

    Thank you so much for this helpful and encouraging information. With the help and support of “The AlgeCalTeam Team” and Medical resources my bone building journey has been less frightening!!

  15. Samantha AlgaeCal

    April 21, 2023 , 7:16 am

    Hello Fatima,

    Thank you so much for your comment – we are so happy to hear that you find the information and our team helpful! We are always here to support you on your bone health journey! 🙂 If you have any further questions or concerns, please give us a call at 1-800-820-0184 (USA & Canada toll-free), and any one of our friendly Bone Health Consultants would be happy to help!

    – Sam @ AlgaeCal

  16. Debbie

    May 16, 2023 , 7:35 pm

    In regards to the later stages of the disease you may be directed towards certain medications, I have a question.
    I have very low bone density and was wondering if these supplements can turn things around or if I need to consider other options as well so I don’t wait until it’s too late. Thank you.

  17. Brianne AlgaeCal

    May 17, 2023 , 7:43 am

    Great question Debbie! While you should always speak with your health care professionals on which medications are right for you, we want to reassure you that you can increase your bone density naturally with AlgaeCal at any age, and from any T score – it’s never too late to get started! We have thousands of customers in our community who have seen wonderful increases over time, and if you’re interested, you can see some of their stories HERE! 🙂

    We’d love to connect with your further, Debbie, so please feel free to reach out to us at 1-800-820-0184 (USA & Canada toll-free) for any additional questions. We have Bone Health Consultants available 7 days a week!

    – Brianne @ AlgaeCal

  18. ELLEN DEGROAT

    May 20, 2023 , 9:40 am

    MANY THANKS FOR THIS EXCELLENT ARTICLE TODAY. WE MUST SHARE THIS INFOMATION WITH ALL OUR FRIENDS BOTH WOMEN AND OUR MEN FRIENDS AS SOON AS POSSIBLE AS THEY NEED THIS INFORMATION!!

    ELLEN

  19. Luz Elena

    August 7, 2023 , 6:44 pm

    Hi, I’m Luz, I have osteoporosis, actually I’m in the treatment with Forteo for 2 years, this November is going to be the two years. I was taking calcium citrate or cal traté for more than 20 years and didn’t help me when I went through the menopause and discovered that I have osteopenia first then turned in osteoporosis. I stopped taking calcium and instead I was taking green juices, my chiropractor recommended this. I don’t know Isfahan this calcium could be good for me. What do I like is because is plant based.
    lunaelena14@ @hotmail.com

  20. Megan @ AlgaeCal

    August 8, 2023 , 10:19 am

    So sorry to hear about your bone loss, Luz. If you’re interested in a safe and natural approach to increasing your bone density, AlgaeCal has helped thousands of women and men do so for many years! You can view some of their inspiring success stories HERE if you like. For more information and personalized support, you can reach our Bone Health Consultants 7 days a week at 1-800-820-0184 (USA & Canada, toll-free) or by email at [email protected]. Let us know if you have any questions!
    – Megan

This article features advice from our industry experts to give you the best possible info through cutting-edge research.

Lara Pizzorno
MDiv, MA, LMT - Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.,
Dr. Liz Lipski
PhD, CNS, FACN, IFMP, BCHN, LDN - Professor and Director of Academic Development, Nutrition programs in Clinical Nutrition at Maryland University of Integrative Health.,
Dr. Loren Fishman
MD, B.Phil.,(oxon.) - Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.,
Prof. Didier Hans
PHD, MBA - Head of Research & Development Center of Bone Diseases, Lausanne University Hospital CHUV, Switzerland,