Vitamin D Deficiency (Adults) - Osteomalacia

Prolonged vitamin D deficiency from inadequate dietary intake or sunlight exposure.

Malabsorption of vitamin D due to gastrointestinal diseases or surgeries.

Chronic renal insufficiency impairing 1-alpha hydroxylase activity.

Medications inducing vitamin D metabolism such as anticonvulsants or glucocorticoids.

Months to years of sustained vitamin D deficiency are typically required before clinical osteomalacia develops.

Gradual onset of symptoms occurs as bone demineralization progresses.

Symptom onset may be delayed in patients with partial vitamin D deficiency or intermittent exposure.

Nonspecific symptoms such as diffuse bone pain and muscle weakness often mimic other musculoskeletal disorders.

Normal or mildly decreased serum calcium can mislead clinicians away from vitamin D deficiency.

Lack of routine vitamin D level testing in patients with bone pain delays diagnosis.

Radiographic changes may be subtle or absent early in disease, leading to missed diagnosis.

Diffuse bone pain and tenderness, often worse at night

Muscle weakness, especially proximal muscles

Difficulty walking and frequent falls

Fractures with minimal trauma

Fatigue and generalized malaise

Progressive diffuse bone pain, especially in the lower back, hips, and legs.

Proximal muscle weakness causing difficulty climbing stairs or rising from a chair.

Fatigue and generalized weakness develop insidiously over months.

History of fractures or skeletal deformities may be present in advanced cases.

History of malabsorptive disorders such as celiac disease or bariatric surgery.

Chronic kidney or liver disease impairing vitamin D metabolism.

Use of medications like anticonvulsants or glucocorticoids that affect vitamin D levels.

Previous fractures or bone pain suggestive of underlying metabolic bone disease.

Usually negative for inherited bone disorders as osteomalacia is primarily acquired.

Rare familial forms of vitamin D–dependent rickets may be considered if early onset occurs.

No consistent familial pattern in typical adult osteomalacia cases.

Bone tenderness on palpation, especially over the ribs, pelvis, and long bones

Proximal muscle weakness with difficulty rising from a chair or climbing stairs

Waddling gait due to hip girdle muscle weakness

Skeletal deformities such as bowing of the legs or pelvic deformities in severe cases

Fractures with minimal trauma, often involving ribs, femur, or vertebrae

Increase safe sunlight exposure to promote endogenous vitamin D synthesis in the skin.

Implement dietary modifications to include calcium-rich foods such as dairy products and leafy greens.

Encourage weight-bearing exercise to improve bone strength and reduce fracture risk.