Rickets and Osteomalacia: Vitamin D Deficiency in Children and Adults

See a clinician first

Rickets and osteomalacia are bone conditions that need a clinician's diagnosis and treatment plan. The NHS (UK) says to see a GP if you think you or your child might have rickets or osteomalacia, and that the GP will check vitamin D and calcium levels, which may include blood and urine tests, and may refer you for X-rays and bone scans. [1] MedlinePlus (US) says to contact your child's health care provider if you notice symptoms of rickets. [2] Do not try to treat a suspected case with supplements on your own, because the right treatment depends on the cause.

What they are

MedlinePlus describes rickets as a disorder in children before bone growth is complete, caused by a lack of vitamin D, calcium or phosphate, which softens and weakens bones. [2] Osteomalacia is softening of the bones in adults, most often because of a problem that leads to vitamin D deficiency. [3] The NHS uses the same split: rickets in children, osteomalacia in adults. [1] Vitamin D helps the body absorb calcium, which bones need to stay strong and hard. [3] The vitamin itself is covered on Vitamin D, and the mineral partnership on Vitamin D and Calcium.

Symptoms

The NHS also lists changes in the way you walk, difficulty climbing stairs or getting out of a chair, and breaking bones more often or after a minor accident. [1] These signs have other causes, so they cannot confirm a diagnosis.

Causes

• Vitamin D. The skin makes vitamin D in sunlight, and it also comes from food. MedlinePlus lists living in climates with little sunlight, staying indoors, working indoors, covering most skin, having dark skin pigmentation and using very strong sunscreen as reasons skin may make too little. [3]
• Diet. Not drinking milk products, lactose intolerance and vegetarian diets are listed as reasons food may not provide enough. [3] MedlinePlus says infants who are breastfed only may develop deficiency, because human breast milk does not supply enough vitamin D, and that this can be a particular problem for darker-skinned children in winter. [2]
• Calcium and phosphate. Diets lacking calcium and phosphorus can lead to rickets, which MedlinePlus says is rare in developed countries. [2]
• Absorption, kidney and liver problems. Disorders that reduce fat absorption make it harder to absorb vitamin D, liver disorders can stop conversion to its active form, and some kidney disorders can cause rickets. [2] Osteomalacia can also follow gastric bypass surgery, kidney failure, liver disease, rare tumors causing low phosphate, and side effects of medicines used to treat seizures. [3]
• Genes. Hereditary rickets occurs when the kidneys cannot hold onto phosphate. [2]

A global consensus statement from 33 experts in 11 international organizations describes nutritional rickets as a preventable global health problem, and calls for supplementation and food fortification programs. [4]

Diagnosis

MedlinePlus lists blood tests (calcium, phosphorus, vitamin D, alkaline phosphatase, parathyroid hormone) and X-rays for rickets. [2] For osteomalacia it adds that bone density testing can make osteomalacia look like osteoporosis, so the results need careful reading. [3] See Vitamin D Deficiency and Testing for what a vitamin D level can and cannot show.

Treatment (clinician-led)

• Rickets. The NHS lists vitamin D and calcium supplements, a healthy balanced diet and more time outside, and says some people need further treatment or surgery for bone problems. [1] MedlinePlus says replacing the missing vitamin D, calcium or phosphorus eliminates most symptoms, and a prescription may be needed if a metabolic problem is the cause. [2]
• Osteomalacia. MedlinePlus says treatment may involve vitamin D, calcium and phosphorus taken by mouth, and people who cannot absorb nutrients well, including some after weight-loss surgery, may need larger amounts. [3] It says healing should happen within 6 months with treatment. [3]
• If another condition is the cause, the NHS says treating that condition helps. [1]
• Outlook. MedlinePlus says laboratory values and X-rays usually improve after about 1 week with treatment, but if rickets is not corrected while a child is still growing, skeletal deformities and short stature may be permanent. [2]
• Amounts for treatment are set by the clinician. We do not give treatment doses.

Prevention: what health bodies say

The NHS rickets page also says to give babies vitamin D drops from birth if they are exclusively breastfed or under 6 months old and have less than 500 ml of formula a day. [1] The Endocrine Society (US, 2024) suggests vitamin D for children and adolescents aged 1 to 18 years to prevent nutritional rickets, and says the optimal doses remain unclear. [7] See Vitamin D and Vitamin K for Newborns and Breastfed Babies.