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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Osteomalacia: More prevalent than we think?

Everyone knows that osteoporosis leads to fractures, especially hip fractures. And almost everyone knows that DEXA scans (now called DXA scans) or other radiographic tests for bone mineral density are used to detect osteoporosis.

However, few people realize that DXA-scans will also detect osteomalacia, the adult form of rickets. The problem is that the doctor always assumes the abnormal calcium content is osteoporosis, rather than raising the question that it might indicate osteomalacia.

DXA-scans tell you nothing about bone quality; they only tell you if you have adequate bone mineralization. DXA scans cannot distinguish between osteoporosis and osteomalacia.

In fact, DXA-scans will only tell you if you have adequate bone calcium. It tells you nothing about the other minerals that bones need, such as magnesium, zinc, boron, copper, manganese, silica, and iron. Of these minerals, the average intakes of magnesium, zinc and boron are likely to be low in the typical American diet.

So how does one detect osteomalacia or adult rickets, if a DXA scan is no good? It is very difficult to test for osteomalacia. Unless it is severe, plain x-rays of bones will be normal.

Osteomalacia is a softening of the bone, making it weak. Under the microscope, osteomalacia is detected by an excess amount of unmineralized osteoid. Osteoid is the protein of bone, it makes up about fifty percent of bone volume and forty percent of bone weight. The predominant protein is collagen, which comprises ninety percent of the osteoid.

So, virtually the only way to detect osteomalacia reliably is by a bone biopsy. That is exactly what Finnish researchers did in 1982; they took bone biopsies of 50 consecutive hip fracture patients.

Hoikka V, Alhava EM, Savolainen K, Parviainen M. Osteomalacia in fractures of the proximal femur. Acta Orthop Scand. 1982 Apr;53(2):255-60.

They found that a startling 24% of these patients had osteomalacia. While osteoporosis was the most common finding, many patients had both osteomalacia and osteoporosis.

An earlier study in the USA found 26% of patients with hip fracture also had osteomalacia.

Sokoloff L. Occult osteomalacia in American (U.S.A.) patients with fracture of the hip. Am J Surg Pathol. 1978 Mar;2(1):21-30.

No one knows what percentage of modern hip fracture patients have osteomalacia. However, I doubt much has changed in 30 years except for increased sun avoidance and thus even more widespread vitamin D deficiency.

  About: John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, emergency physician, and psychiatrist.

9 Responses to Osteomalacia: More prevalent than we think?

  1. Rebecca Oshiro says:

    My puzzling bone pain disappeared with 5,000 IU of vitamin D per day. It terrifies me to think what my bones would have been like several decades down the road if I had not started taking D.

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  2. Magic says:

    It terrifies me how many people are suffering………..and dying from lack of D3…

    How many people are stuck in nursing homes getting NO sunshine or vitamins……and dying.

    I have seen it in the last 18 months

    I don’t like to get carried away……BUT I BELIEVE IT…


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  3. Rebecca Oshiro says:

    And yet there I was, at 27 years of age, suffering from bone pain. Thank you, IOM, for assuring me that my 22 ng/mL 25(OH)D level was adequate for skeletal health.

    My boss, a doctor, told me he is not a fan of Vitamin D Council material because it is too “silver bullet.” I would say more than any other field, the nutrition field discourages silver bullet style thinking. All of my training emphasized “patterns over time,” with explicitly suspicious instruction regarding supplements. I have been an outspoken critic regarding supplements for years (In general I prefer people make dietary changes long before considering a supplement), and yet I can not ignore what I have seen vitamin D do over and over again for many, many people. It is the closest thing in the nutrition field to a silver bullet.

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  4. Magic says:


    My plan exactly.

    First make sure it will not harm…………and then GO FOR IT!


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  5. Rita and Misty says:

    I was reared on Rodale and Adele Davis…rather than Dr. Spock…

    My entire life has been one of organic foods, supplements as appropriate and tons of exercise.

    At age 40 I had my first 25(OH)D test. I tested at 32 ng/ml. I was sick, and getting sicker.

    At age 46, I discovered the Vitamin D Council, and I supplemented to correct my 25(OH)D level to 74 ng/ml. My health turned around completely.

    I look and feel fantastic, and even during the most stressful times, my mood is always at least partly sunny.

    Yes, Magic, I too am sold.

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  6. IAW says:

    To Rebecca: It is absolutely beyond my comprehension that doctors cannot see the difference between a vitamin/supplement and a pre-hormone/essential nutrient that was “originally” only produced from the sun striking our skin. I will repeat myself again. Just what do/did doctors learn about “Vitamin D” as they go/went through medical school. I have no medical background and yet I get that it’s NOT just a Vitamin even though we call it one.

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  7. Rita and Misty says:

    Greetings IAW~~

    Magic and I were just discussing this point the other day. I happen to feel as you, that vitamin d should be renamed to what it actually is: pro-hormone d. But Magic did raise a good point. Many people will be scared to supplement with a “hormone.”

    It’s a dilemma for sure!

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  8. Magic says:

    It’s too “silver bullet.” 400 international units are enough…………..You don’t need D3 you can get the same with Lipitor….1000 could be toxic…. More could poison you…etc The internet is all junk…Don’t believe it…

    These are all stories from Big Pharma sales people. In the dog park a guy told me he used to be one of them, he now owns a landscaping business here in Eugene. He was making great money but “couldn’t take it any longer.


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  9. Rita and Misty says:

    I love my vitamin d3..and my sunshine…

    (please try to stay away from lawn care chemicals…poison..imo)

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