Osteomalacia and osteoporosis are conditions that affect bone tissue and bone formation. Doctors characterize osteomalacia as softening bone, and osteoporosis refers to a loss of bone density.

While osteomalacia and osteoporosis weaken the bones, they act in different ways. Their symptoms, causes, diagnoses, and treatments are also different.

In osteomalacia, the new bone does not harden as it should, and the bone tissue becomes soft. In osteoporosis, the bone becomes weak and thin because of a disruption in bone formation and bone loss.

This article compares osteomalacia and osteoporosis and looks at the diagnosis, treatments, and outlooks for both.

An X-ray image of a foot, representing osteoporosis vs. osteomalacia. -2Share on Pinterest
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Osteomalacia and osteoporosis are both conditions that affect the bones.


In osteomalacia, the bones do not harden as they should during a process called bone turnover, which occurs throughout a person’s life.

Bone turnover is a process in which cells called osteoclasts reabsorb old bone tissue. Cells called osteoblasts then replace it with new bone. The new bone tissue starts as a soft inner layer called collagen.

Minerals usually coat the collagen layer in a hard, protective shell. However, in a person with osteomalacia, the coating does not form completely. This leaves the bones weakened as the soft collagen layer is exposed.

This malformation can result from vitamin D and calcium deficiencies. In rare cases, it can occur due to inherited genetic disorders.


Osteoporosis also occurs due to problems in the process of bone turnover.

In a person with osteoporosis, the body breaks down more bone tissue than it replaces. This results in bones becoming porous, with a thin outer layer. The bones may become weak to the point where they can easily break.

The risk of osteoporosis increases as a person ages. Additionally, decreased estrogen levels can cause osteoporosis, so people experiencing menopause are at a higher risk of the condition.

Can a person have both?

A person can have both osteomalacia and osteoporosis, although the latter is the more common disease of the two.

Below is a comparison of the symptoms and causes of osteomalacia and osteoporosis.

SymptomsSymptoms may include:
muscle spasms
• muscle weakness
joint and muscle pain
• aching bone pain, especially in the lower limbs, lower spine, and pelvis
atypical gait
• spinal, pelvic, or limb deformities
seizure due to a lack of vitamin D
• increased falls
Osteoporosis may not present symptoms until a person has broken a bone.

Symptoms may include:
• symptoms of a spinal fracture, such as severe back pain or hunched posture
fractures in bones from falling, bending, coughing, or lifting
CausesCauses and risk factors include low levels of vitamin D and factors and health conditions that may lead to vitamin D deficiency, such as:
• aging
• pregnancy
Crohn’s disease
• celiac disease
• cystic fibrosis
• nephrotic syndrome
• chronic kidney disease
• liver disease
• certain medications, including anti-epileptic drugs and antifungal agents
Factors that increase a person’s risk of osteoporosis include:
• aging
• a diet low in calcium and vitamin D
• sex, as females are more likely to develop the disease
• family history of osteoporosis
• race, as Asian and white people are more likely to develop the disease
• body size, as slender people with thin bones are at greater risk
• hormonal changes, such as lower levels of estrogen
• low levels of physical activity
• excessive use of alcohol
• other medical conditions, such as anorexia nervosa and rheumatoid arthritis
• certain medications, such as selective serotonin reuptake inhibitors and cancer medications
Diagnosis Doctors may ask about symptoms of bone weakness, and order tests such as:

• urine and blood analysis to test hormone, enzyme, and mineral levels
X-rays to determine bone mineral density (BMD)
To diagnose osteoporosis, doctors may:

• perform a physical exam
• test BMD with a dual-energy X-ray absorptiometry
• look for fractures
TreatmentTreatment mainly focuses on correcting vitamin D and electrolyte deficiencies and treating the underlying causes.

Doctors may suggest changes to a person’s diet as well as vitamin D, calcium, and phosphate supplements.
Treatment may include:

• changes to nutrition that include plenty of vitamin D, calcium, and other nutrients
• calcium and vitamin D supplements
• lifestyle changes, such as stopping smoking and increasing physical activity
hormone therapy and estrogen

The outlook for osteomalacia is generally positive. Because issues with vitamin D are typically the cause of the disease, doctors can often treat and cure osteomalacia.

Once a person has begun treatment, their bones usually begin to normalize within weeks, although healing can take a few months to a year.

The outlook for osteoporosis is typically favorable if a person can detect the disease early. If they do not receive treatment early, they may experience fractures and chronic pain.

Osteoporosis can lead to disability and a loss of independence.

Below are the answers to some frequently asked questions about osteomalacia and osteoporosis.

What is the difference between osteomalacia and rickets?

Rickets is a condition that occurs in children whose bones are still in the process of developing, while osteomalacia occurs in adults.

What is the difference between osteomalacia and osteoarthritis?

Osteomalacia affects bone strength and occurs when bones become soft through dysfunction in the bone turnover process.

Osteoarthritis is a degenerative joint disease in which cartilage in the joints wears down over time and causes stiffness, pain, swelling, and decreased mobility.

Osteomalacia and osteoporosis are both conditions that affect bone strength. However, the causes, symptoms, diagnoses, and treatments of each are different.

In osteomalacia, the new bone does not harden, and the bone tissue becomes soft. In osteoporosis, the bone becomes weak and thin because of a disruption in bone formation and bone loss.