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Osteomalacia and Rickets – Quick revision card

Osteomalacia and rickets – defective bone mineralization. Impaired Vitamin D , Phosphorus or calcium metabolism. Osteomalacia ( soft bones ) is defective bone mineralization of the osteoid matrix in the cortical and trabecular bones leading to accumulation of osteoid tissue ( mineralized bone is reduced and osteoid component become excessive )

Rickets – Defective mineralization and widening of the
 epiphyseal ( or growth ) plate in children Osteomalacia and rickets can happen together in children but osteomalacia only happens .


Vitamin D deficiency ( most common cause of both rickets and osteomalacia ) Calcium malabsorption from any cause Secondary hyperparathyroidism ( high bone turnover ) Phosphate depletion from any cause Hereditary hypophosphatemic rickets syndromes Enzyme defects ( Hypophosphatasia – a rare condition ) Toxic effects of various drugs Chronic kidney and liver disease Renal tubular acidosis


Osteomalacia – symptoms can be non-specific diffuse bone pain , proximal muscle weakness and wasting , myalgia , arthralgias , waddling gait bone fragility fractures ( looser zones ) and pseudofractures deformities – long term osteomalacia falls ( increased prevalence in the elderly ) BMD is not required for diagnosis of osteomalacia & reduced BMD does not distinguish between osteoporosis and osteomalacia No single lab test is specific but low phosphate or low calcium & increased alkaline phosphatase – should trigger a suspicion of osteomalacian .


common disease worldwide skeletal deformities ( parietal & frontal bossing , craniotabes , rachitic rosary , Harrison’s sulcus, widening of ankle , genu varum , genu vulgum ) extraskelatal findings can include – pain , irritability , delay in motor milestones , poor growth diagnosed on evaluation ( clinical signs ) history
( diatary , medications , liver or renal disease , malabsorption ) and biochemical profile ( raised alkaline phosphatase , reduced vit D ) specific radiographic findings ( metaphyseal cupping and flaring , bowing of legs ) two major types phosphopenic and calcipenic

Bone biopsy with tetracycline labelling is the most accurate way to diagnose osteomalacia / ricketsadults


  1. Zimmerman L, McKeon B. Osteomalacia. [Updated 2021 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  2. Dahash BA, Sankararaman S. Rickets. [Updated 2021 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  3. Osteomalacia and Vitamin D Status: A Clinical Update 2020
    Salvatore Minisola,1 Luciano Colangelo,1 Jessica Pepe,1 Daniele Diacinti,1 Cristiana Cipriani,1 and Sudhaker D Rao2 Osteomalacia and Vitamin D Status: A Clinical Update 2020 – Minisola – 2021 – JBMR Plus – Wiley Online Library
  4. Sahay, Manisha, and Rakesh Sahay. “Rickets-vitamin D deficiency and dependency.” Indian journal of endocrinology and metabolism vol. 16,2 (2012): 164-76. doi:10.4103/2230-8210.93732


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