Rickets and osteomalacia
Rickets and osteomalacia are the same disorder at different ages: the bones do not receive enough minerals and become soft.
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Medicines commonly prescribed for Rickets and osteomalacia
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CHEWABLE TABLET, 600 mgActive substance: calcium carbonateManufacturer: Italfarmaco S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 1 mg cholecalciferol cholesteryl esterActive substance: colecalciferolManufacturer: Kern Pharma S.L.Prescription requiredDosage form: Soft capsule, 0.625 mgActive substance: colecalciferolManufacturer: Teva B.V.Prescription required
Rickets and osteomalacia are the same disorder at different ages: the bones do not receive enough minerals and become soft. In children, while the growth plates are still open, it is called rickets; in adults, osteomalacia. In both cases the main cause is a lack of vitamin D, which means that in most situations the condition can be prevented and treated by simple means.
Symptoms in children
- bone pain; the child does not want to walk and asks to be carried;
- slowed growth;
- bowed or knock-kneed legs, noticeable once the child starts walking;
- thickening at the wrists, ankles and ribs;
- late closure of the fontanelle and soft edges to the skull bones;
- late tooth eruption, weak enamel, multiple caries;
- muscle weakness and lethargy;
- fractures from minor injury;
- in infants with marked deficiency: seizures from low calcium, irritability and sweating.
Symptoms in adults
Osteomalacia is easily missed: the complaints are vague and are often put down to age or tiredness.
- dull bone pain — lower back, pelvis, hips, ribs; worse on weight-bearing and pressure;
- muscle weakness, especially in the thighs: it becomes hard to climb stairs or rise from a chair;
- a waddling gait;
- fractures from minimal trauma, including stress fractures;
- general tiredness;
- sometimes tingling and cramps, from low calcium.
Causes
- lack of vitamin D — little sunlight, darker skin, covering clothing, indoor work, northern latitudes, winter months;
- insufficient dietary calcium;
- absorption problems — coeliac disease, Crohn's disease, previous bariatric surgery, chronic pancreatitis;
- kidney disease — vitamin D is not converted to its active form;
- liver disease;
- medicines — antiepileptics, some antivirals, long-term corticosteroids;
- breastfeeding without vitamin D supplementation — breast milk contains almost none, so supplementation is needed for all infants;
- rare inherited forms linked to phosphate loss through the kidneys; these do not respond to ordinary vitamin D and need a different approach.
When to see a doctor
- a child's legs have become bowed, they are falling behind in height or do not want to walk;
- tooth eruption is delayed and there is a lot of decay;
- an adult has persistent dull bone pain and weakness in the thighs;
- a fracture has occurred after minor injury;
- you have bowel, kidney or liver disease and have developed bone pain;
- you have taken antiepileptics or corticosteroids long term;
- an infant has a seizure — this needs emergency care;
- you are almost never outdoors and wear covering clothing.
How it is investigated
Blood tests: vitamin D (25-OH), calcium, phosphate, alkaline phosphatase — often raised and the first clue — parathyroid hormone, creatinine and liver function. Where needed, coeliac screening and urinary calcium and phosphate.
Imaging: X-rays show characteristic changes at the growth plates in children and stress fractures in the pelvis and femur in adults. Bone density scanning shows reduced density but cannot on its own distinguish osteomalacia from osteoporosis — and the treatments differ, which is exactly why the blood tests matter.
Treatment
This is one of those situations where treatment is straightforward and the result is obvious: pain reduces within weeks and bone changes in children gradually correct themselves.
- vitamin D at a treatment dose as a course, followed by a maintenance dose. The dose is set by a doctor according to blood levels and age;
- calcium from diet or supplements if intake is insufficient;
- active forms of vitamin D in kidney and liver disease, where the ordinary form does not work;
- phosphate and specific medicines in the inherited forms, under specialist supervision;
- treating the underlying condition — coeliac disease, bowel disease;
- follow-up blood tests at 2–3 months and less often thereafter;
- orthopaedic assessment if significant leg deformity persists; often after treatment surgery turns out not to be needed.
Prevention
- vitamin D daily for all infants from the first days of life, regardless of feeding method; formula-fed babies get part of the dose from the formula and the doctor will adjust accordingly;
- vitamin D in autumn and winter for children and adults at risk, and year-round for some;
- moderate sun exposure without burning;
- in the diet: oily fish, eggs, fortified foods, dairy or its calcium-containing alternatives;
- particular attention to pregnant and breastfeeding women, people with darker skin, those who wear covering clothing and older people who rarely leave the house;
- in bowel and kidney disease, check vitamin D levels regularly.
Common questions
Is this the same as osteoporosis? No. In osteoporosis the bone is normal in composition but there is less of it. In osteomalacia the bone is there but inadequately mineralised. Treatment differs.
Is sunlight enough? In season and in southern latitudes, often yes. In winter and in the north the skin produces virtually no vitamin D.
Can diet cover it? It is difficult: an ordinary diet contains little vitamin D. That is why supplements exist.
Will a child's legs straighten? In most cases yes, particularly if treatment begins early.
Can you take too much vitamin D? Yes, with high doses over a long period and without monitoring. That is why the dose is prescribed and checked by blood test.
Online consultation
In an online consultation the doctor reviews symptoms and results, helps distinguish osteomalacia from osteoporosis, sets the vitamin D and calcium dose for your case, checks for causes of poor absorption and sets up a monitoring schedule.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 16, 2026
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