Osteopenia vs Osteomalacia – Causes & Differences


Osteopenia, also referred to as low bone density, is an indication that your mineral density is below normal.

It is something which is seen mostly in women above the age of 30, however, men can also have this condition.


Most people do not know they have low bone density until they have a bone density test. When symptoms do occur, some of the most common symptoms include:

  • problems exercising normally due to injuries or pains;
  • dealing with bone pains and other aches which affect tissues near the bones, including the joints;
  • suffering from one or more bone breaks or fractures. When a bone break occurs, it is most likely to affect someone’s ankle, hip, wrist, or spine.


Some of the risk factors and causes for the condition include:


Drugs which lead to lowered bone density include:

  • certain diuretics;
  • Phenytoin;
  • Thyroid hormone replacement;
  • Depo-Provera;
  • Lithium;
  • drugs with aluminum;
  • Heparin;
  • Dilantin;
  • proton pump inhibitors such as omeprazole;
  • Methotrexate;
  • Phenobarbital;
  • immunosuppressants such as Cyclosporine A and FK506;
  • aromatase inhibitors;
  • GnRH – agonists such as leuprolide;
  • anticancer drugs.

Post-Menopausal Women

During reproductive age, females produce estrogen from their ovaries. After menopause, there is a decline of estrogen that leads to bone loss.


People treated for the following diseases and conditions:

  • cerebral palsy;
  • some types of cancers;
  • malabsorption syndromes;
  • organ transplant;
  • epilepsy (the fourth most common neurological disorder);
  • lymphoma;
  • hypogonadism;
  • lupus;
  • lactose intolerance;
  • leukemia;
  • arthritis;
  • vitamin B12 deficiency;
  • diabetes;
  • bulimia and anorexia;
  • thalassemia (a blood disorder in which the body makes an abnormal form of hemoglobin);
  • asthma;
  • chronic kidney disease;
  • skin disorders;
  • celiac disease;
  • sickle cell anemia (a group of blood disorders);
  • polio;
  • hyperthyroidism and hyperparathyroidism;
  • Cushing’s syndrome;
  • ulcerative colitis;
  • Crohn’s disease;
  • osteogenesis imperfecta (a group of genetic disorders which mostly affect the bones);
  • multiple myelomas;
  • liver disease.
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Many people are genetically predisposed to the condition.

Other causes include:

  • aging, as the bone loss is a normal feature of aging;
  • teenage pregnancy;
  • young female athletes with amenorrhea (the absence of menstruation) and eating disorders;
  • lack of physical exercise and a sedentary lifestyle;
  • excessive coffee, soda, tea, sports and energy drinks, or chocolate since they all contain caffeine, a central nervous system stimulant that decreases the bone mineral density;
  • crash dieting;
  • excessive emotional stress;
  • excessive smoking (as well as second-hand smoking);
  • excessive alcohol consumption.


The condition is diagnosed with a bone mineral density test, the most accurate being a special detector in a scanner that measures how much radiation passes through your bones, called dual-energy X-ray absorptiometry scan.


It can be treated either with physical exercise and nutrition as well as with medications.


Osteomalacia is a medical condition in which the bones become soft commonly due to a deficiency of vitamin D.

Vitamin D is produced by the human body when the ultraviolet rays of the sun are absorbed by the skin. Vitamin D (also known as the sunshine vitamin) is essential for building the bone structure.

A lack of vitamin D produced by the skin may occur in individuals who:

  • use very strong sunscreen;
  • have dark skin pigmentation;
  • wear clothes which cover most of their skin;
  • work indoors during the daylight hours;
  • must stay indoors;
  • live in climates with little exposure to sunlight.


If you have this condition, you may experience the following symptoms:

  • weak muscles in your thighs and arms;
  • trouble walking up stairs or getting up from sitting;
  • stiffness;
  • pain;
  • feeling tired;
  • easily broken bones.
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The condition can be caused by having a low level of vitamin D. Even though severe vitamin D deficiency is rare in the US, most people do not achieve good vitamin D levels from sources which include diet, sunlight, and supplements.

Other causes of osteomalacia include:

  • the use of epilepsy tablets;
  • kidney failure;
  • liver disease;
  • gut problems, for instance – previous surgery on the stomach or untreated coeliac disease.

Risk Factors

People at risk of developing the condition are:

  • people with dark skin or those who use strong sunscreens which block the absorption of the rays of the sun;
  • people who do not consume enough dairy products or are lactose intolerant;
  • people living in institutions, such as the elderly who live in long-term care;
  • people living in the far northern parts of the world (Scandinavia, Alaska), due to shorter sunlight hours.


The following tests may help make the diagnosis:

  • a bone biopsy – during this test a needle is inserted into the bone to allow the healthcare provider to remove a small piece of bone tissue for analysis;
  • computed tomography scans of the spine;
  • X-rays – images of the leg bones to look for abnormalities, like pseudofractures;
  • urine tests;
  • kidney function;
  • blood tests to measure levels of phosphate, calcium, and vitamin D.


Treatments usually include taking calcium, vitamin D, or phosphate (used by people who are unable to get sufficient phosphorus in their regular diet) supplements, depending on the individual case.


The prognosis of the condition is good if underlying causes of vitamin D deficiency are addressed. Sufferers should be encouraged to ensure adequate sun exposure and eat a balanced diet.

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A diet rich in vitamin D and exposure to sunlight can help prevent the condition. Vitamin D is found in large amounts in fortified cereals, cod liver oil, dairy products (yogurt, milk), oily fish (mackerel, salmon, and sardines), and egg yolks.

Bottom Line – Osteopenia vs Osteomalacia

Osteopenia is a loss of bone mineral density which is a common precursor of osteoporosis (a disease that weakens bones to the point where they break easily). Being thin, having a family history of osteoporosis, being Asian or Caucasian, smoking tobacco (and second-hand smoking), lack of adequate physical activity, drinking excessive amounts of alcohol, and regular consumption of sodas increases the risk of osteopenia.

Osteomalacia is a condition of bones in which the bones have a tendency to get fractured and become extremely fragile and soft. When the same thing happens in children, it is called rickets. Symptoms include:

  • numbness around the mouth or in the legs and arms;
  • pain or tenderness in the bones;
  • waddling gait and/or difficulty walking;
  • muscle weakness, especially in the buttocks and thighs;
  • muscle spasms and/or cramps.

In conclusion, osteomalacia is different from osteopenia as osteomalacia is linked with a decrease in bone volume and excess osteoid accumulation whereas osteopenia eventually leads to osteoporosis, which in turn leads to the quantum decrease in bone mineral volume, however, without mineralization defect.