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Osteomalacia Vs. Osteoporosis: What's The Difference?

Osteomalacia and osteoporosis are both conditions affecting the bones. Knowing the causes and risk factors for both can help a doctor diagnose your condition.

Bone health is important for a healthy body. Osteoporosis and osteomalacia are two diseases that affect the bones. While they both weaken the bones, they act in different ways.

Knowing the difference between the two can help you talk with a medical professional about your symptoms and get the appropriate diagnosis and treatment.

Osteomalacia and osteoporosis are two different conditions that affect the bones.

Osteomalacia

Osteomalacia is a condition that softens bones. In children, it's called rickets. It involves problems with bone formation and the bone-building process, resulting in the weakening of the bones.

It is most often caused by a vitamin D deficiency, which helps you absorb calcium.

issues in your diet

lack of sun exposure

intestinal issues

Sometimes the body has trouble absorbing vitamin D, leading to a deficiency. Various health conditions can cause problems with nutrient absorption, including:

celiac disease

certain kinds of cancer

kidney and liver disorders

medications for certain conditions like seizures

Osteoporosis

Osteoporosis occurs when bone mineral density and mass decrease or when the quality or structure of the bone changes. Over time, this can reduce bone strength, increasing the risk of fractures.

The inside of a bone typically has spaces similar to a honeycomb structure. In osteoporosis, these spaces are bigger than in healthy bones, which weakens the bone.

The biggest risk factor for osteoporosis is age. Your body breaks down bone faster than it replaces it, making bones weaker and more prone to fracture. Menopause can also be a risk factor because changes in hormone levels lead to quicker bone loss.

family history of osteoporosis

poor nutrition

smoking

low body weight

small body frame

According to research provided by the National Osteoporosis Foundation, osteoporosis is more common in women, with the highest occurrence in white and Asian women.

Can you have both?

It's possible to have both osteoporosis and osteomalacia. Low bone density that could be classified as osteoporosis has been found in up to 70% of people with osteomalacia.

It's important to distinguish this secondary osteoporosis from primary osteoporosis, as the focus and treatment are different.

Diagnosis for each condition is a little different.

Osteomalacia diagnosis

For osteomalacia, a blood test can typically yield a diagnosis. The blood test measures:

calcium

phosphorus

vitamin D levels

Other blood tests may be ordered as well, including those to check for:

alkaline phosphatase, which is made by cells that make bone and is elevated in those with osteomalacia

parathyroid hormone, which is raised as a response to low vitamin D levels

an X-ray, which may show any small cracks or fractures in bone

Osteoporosis diagnosis

Osteoporosis is usually diagnosed during a routine screening for the condition. Routine screenings are done for women over age 65 years or women of any age who have certain risk factors.

Tools used in making a diagnosis include:

medical history, including previous fractures, lifestyle behaviors, and family history

physical exam, including balance, gait, and muscle strength

bone mineral density testing like a DXA scan

Bone mineral density testing can help:

find low bone density that can later lead to osteoporosis

diagnose osteoporosis

monitor the effectiveness of your osteoporosis treatments

It uses X-rays to measure the density of the bones.

Treatments for osteomalacia and osteoporosis also differ.

Osteomalacia treatments

If osteomalacia is found early enough, your doctor may recommend vitamin D, calcium, or phosphate supplements. Sometimes, vitamin D is also given intravenously, or through an injection into the vein.

If you have an underlying medical condition that interferes with absorption of vitamin D, treating that condition is necessary as well.

Sometimes children with osteomalacia may need to wear braces or have surgery to fix any bone abnormalities.

Osteoporosis treatments

Treatment for osteoporosis focuses on slowing or stopping bone loss and preventing fractures.

Nutritional changes: Helpful dietary tips include eating a variety of fruits and vegetables, adjusting your calorie intake, and ensuring you're consuming enough calcium, vitamin D, and protein.

Lifestyle changes: Making changes such as quitting smoking if you smoke, reducing alcohol intake, and regular checkups with a medical professional are important in managing your condition and symptoms associated with it.

Incorporating exercise into your routine: You'll want to focus specifically on strength or resistance training, including any specific exercises a physical therapist or rehabilitation specialist recommend.

Speaking with an occupational therapist: They can help you put fall prevention strategies into place.

Taking medication: Medications are also used to strengthen bones and prevent further bone loss. Medications include:

bisphosphonates

calcitonin

estrogen agonist/antagonist

estrogen and hormone therapy

parathyroid hormone analog and parathyroid hormone-related protein analog

RANK ligand (RANKL) inhibitor

Sclerostin inhibitor

Prevention also depends on the condition.

Osteomalacia prevention

Osteomalacia may not always be preventable, such as if it's due to another medical condition. For osteomalacia due to a lack of sun exposure or vitamin D deficiency, there are things you can do to reduce your risk.

Eating foods high in vitamin D, such as:

oily fish

eggs

mushrooms

fortified foods like cereal, milk, yogurt, and bread

Taking supplements if necessary

Osteoporosis prevention

To reduce your risk for developing osteoporosis, there are steps you can take to help protect your bones, including:

getting enough calcium and vitamin D

eating a balanced diet

consuming foods that boost bone health like fruits and vegetables

considering quitting smoking, if you smoke and limiting alcohol intake to one to three drinks per day

OSTEOMALACIA OF THE MOTHER AND INTRAUTERINE GROWTH

It has been suggested that vitamin D deficiency in pregnancy may affect fetal growth (BrMedJ1980;280:751-4).

In the present study we measured crown-heel length of the newborn, and free calcium, phosphorous, calcidiol, calcitriol, osteocalcin and intact parathyroid hormone (PTH) in venous cord blood and in serum from 30 Pakistani and 23 Norwegian women just after delivery.

Results: The Pakistani mothers had lower calcidiol levels (mean ± SD) than the Norwegians (p<0,0001); 15,1 +8,6 and 43,1 ±21,3 nmol/l, respectively. There were also lower osteocalcin values in venous cord blood obtained from the Pakistanis (p=0,0005).

None of the Norwegian mothers had intact PTH>5,5 pmol/l, while 43% (13/30) of the Pakistanis had. The crown-heel length of the Pakistani infants in this group were redused (p=0,01) and their mothers had lower free calcium (p=0,003), than the other Pakistani mothers.

Conclusion: Biochemical signs of depressed bone mineralisation were observed in fetuses of Pakistani mothers with vitamin D deficiency. Redused intrauterine growth were observed when the mothers had both vitamin D deficiency and elevated PTH.

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