Osteomalacia vs Osteoporosis | Important Differences!
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
November 9, 2023

Osteoporosis and Osteomalacia are two bone conditions that, despite being related to bone health, have distinct causes, symptoms, and treatment approaches.

Understanding these differences is crucial for properly diagnosing and managing osteomalacia vs osteoporosis.

What is Osteoporosis?osteoporosis written on chalkboard

Osteoporosis is a medical condition characterized by weakened bones, which become fragile and more likely to break.

It occurs when the creation of new bone doesn’t keep up with the removal of old bone.

Bones become less dense, their structure deteriorates, and they lose strength.

This decrease in bone density and quality can lead to increased risks of fractures, often in the hip, spine, and wrist.

Osteoporosis is more common in older adults, particularly postmenopausal women, due to lower levels of estrogen, a hormone that helps maintain bone density.

Factors such as genetic predisposition, dietary deficiencies, a sedentary lifestyle, certain medications (steroids and seizure medications – also called secondary osteoporosis), and other diseases can contribute to the development of osteoporosis.

Men can also be osteoporotic.

Osteoporosis-associated fractures are common in women after 55 years and after 65 years in men.

If you want to receive an inexpensive bone density scan and several other preventive medicine screenings, read my Life Line Screening Review here. 

Symptoms of osteoporosis

  • Frequent fractures
  • Back pain due to collapsed vertebra
  • Loss of height over time
  • Stooped posture


What is Osteomalacia?

In osteomalacia, the bones remain softer than normal due to an incomplete process of bone turnover, which occurs continually over a person’s life.

During bone turnover, specific cells known as osteoclasts break down old bone, and another type, osteoblasts, create new bone.

Initially, this new bone is just a soft layer called collagen.

Then, minerals will form a hard, protective outer coating over the collagen, providing strength.

But with osteomalacia, this mineral layer doesn’t fully develop, resulting in less sturdy bones because the collagen layer isn’t adequately protected.

The primary causes of this bone deformity are calcium and vitamin D deficiency.

Although uncommon, some genetic disorders passed through families can also lead to this condition.


Symptoms of Osteomalacia

  • Bone pain and tenderness
  • Muscle weakness
  • Difficulty walking

In the video below, Dr. Risa Kagan, MD, compares osteomalacia vs osteoporosis vs osteopenia:

Comparison Table: Osteomalacia vs Osteoporosis

The table below compares the differences in the causes, symptoms, diagnosis, and treatment between osteomalacia and osteoporosis:

Osteomalacia vs Osteoporosis: Symptoms, Causes, Diagnosis, and Treatment

SymptomsAbnormal walking
Muscle weakness and spasms
Muscle and bone pain
Deformities in the pelvis, spine, or limbs
Increase in falls and injuries
Seizures due to low Vitamin D
Severe back pain or poor posture due to spine fracture
Falling, coughing, lifting objects, or falling can result in fractures
CausesAging process
Kidney disease
Liver disease
Celiac disease
Crohn's disease
Cystic fibrosis
Certain medications (anti-seizure and antifungal drugs)
Family history of osteoporosis
Female sex
diet low in calcium and Vitamin D
Caucasian and Asian people more at risk
Menopause (low estrogen)
Overuse of alcohol
Slender, petite people more at risk
Rheumatoid arthritis
Certain drugs (SSRIs and cancer drugs)
DiagnosisBlood and urine tests to check for hormone and mineral levels
X-rays to check for bone mineral density
Bone mineral density check using dual-energy X-ray absorptiometry (DEXA scan)
Physical check by doctor to look for fractures
TreatmentCorrecting low Vitamin D and Calcium by supplementation
Changes to diet to increase deficient nutrients
Lifestyle changes (quitting smoking, exercising)
Eating more nutritious food
Supplementation with Vitamin D and Calcium
Specialized medication and hormone therapy (for women)

Treatment of Osteomalacia

Treating osteomalacia typically involves addressing the underlying deficiencies that cause the condition, primarily by replenishing low vitamin D and calcium levels.

Here’s a general approach to treatment:

  1. Vitamin D Supplementation: High doses of vitamin D are usually prescribed to restore normal levels. This can be done through diet, exposure to sunlight, and supplements.
  2. Calcium Intake: Adequate calcium through diet or supplements is crucial for bone health. The amount needed can vary based on the individual’s condition and dietary habits.
  3. Phosphate Supplementation: In cases where osteomalacia is due to a phosphate deficiency, supplements may be necessary.
  4. Treatment of Underlying Disorders: If osteomalacia results from a digestive disorder or other medical condition, treating that condition is essential for improving bone health.
  5. Medication Adjustment: A healthcare provider may adjust the medication regimen if the osteomalacia is medication-induced.
  6. Regular Monitoring: Blood tests to monitor levels of vitamin D, calcium, and phosphate, as well as bone density scans, can help track treatment progress.
  7. Lifestyle Changes: Modifying diet, increasing safe sun exposure, and engaging in weight-bearing exercises can help strengthen bones and prevent further bone loss.

Regular follow-up is necessary to ensure the treatment is effective and to make adjustments as needed.

Treatment of Osteoporosis

Treating osteoporosis involves a combination of medication, lifestyle adjustments, and dietary changes to strengthen bones and prevent fractures.

Here’s an overview of the treatment strategies:

  1. Medications:
    • Bisphosphonates: These are the most common medications prescribed for osteoporosis treatment. They help prevent bone loss and reduce the risk of fractures.
    • Monoclonal Antibodies: Drugs like denosumab can help to slow bone breakdown and improve bone density.
    • Hormone-Related Therapy: For women, estrogen therapy or hormone replacement therapy (HRT) may be considered, especially for those in early menopause. For men and women, medications that mimic parathyroid hormone can help to rebuild bone.
    • Selective Estrogen Receptor Modulators (SERMs): These mimic estrogen’s bone-preserving effects and are used particularly in postmenopausal women.
    • Calcitonin: This hormone helps regulate bone metabolism and may be used to treat osteoporosis, especially in women who are at least five years postmenopause.
  2. Supplements and Diet:
    • Calcium: Adequate calcium intake is crucial for bone health. It can be increased through diet or supplements if dietary calcium is insufficient.
    • Vitamin D: This vitamin is essential for the body to absorb calcium. Supplementation may be necessary if levels are low or sun exposure is insufficient.
  3. Lifestyle Changes:
    • Exercise: Regular weight-bearing and muscle-strengthening exercises can help build bone strength, improve balance, and reduce the risk of falling and fractures.
    • Fall Prevention: Measures to prevent falls in the home, such as removing tripping hazards and using assistive devices if needed, can help prevent fractures.
    • Quitting Smoking and Reducing Alcohol: Smoking and excessive alcohol consumption can contribute to bone loss.
  4. Regular Monitoring:
    • Bone Density Tests: Regular scans can monitor the effectiveness of treatment and progression of the disease.
  5. Rehabilitation:
    • Physical Therapy: Physical therapists can design personalized exercise programs that focus on bone health and fall prevention.

It’s important for individuals to work closely with their healthcare provider to determine the best treatment plan based on their specific circumstances, including the severity of osteoporosis, the presence of other health conditions, and personal risk factors.

Like the management of osteomalacia above, regular monitoring and keeping your doctor’s appointments is a must.

Prevention Strategies

Preventive measures for both conditions include:

  • Adequate intake of calcium and vitamin D
  • Regular weight-bearing exercise
  • Avoidance of smoking and excessive alcohol intake
  • Regular screening for those at risk


While osteomalacia and osteoporosis share similarities as bone disease, they differ significantly in their pathophysiology, clinical manifestations, and treatment.

Early detection and appropriate intervention can manage both conditions effectively, minimizing the risk of fractures and maintaining quality of life.

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