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Osteomalacia is due to failure of mineralization of osteoid; 'rickets' is osteomalacia affecting children

In osteomalacia there is normal deposition of bone osteoid by osteoblasts, and bone architecture is normal. However, there is inadequate mineralization so that, for example, only the centre of bony trabecula are adequately mineralized, the periphery being composed of soft unmineralized osteoid.

Osteomalacia is usually the result of abnormalities of vitamin D metabolism Through its effect on calcium metabolism, an inadequate supply of vitamin D, for whatever reason, is the most important cause of osteomalacia. Vitamin D deficiency may be due to:

Inadequate dietary intake. Formerly the most common cause of osteomalacia in children, this is now 
rare in the Western World, except in people who have extreme diets, e.g. pure vegans.

Inadequate body synthesis of vitamin D. As vitamin D is synthesized in the skin under the influence of UV light, extensive covering of the skin for social and cultural reasons may be an important contributory factor in osteomalacia.
The above two factors are responsible for the high incidence of osteomalacia in natives of the Indian subcontinent living in the UK and other European countries. In Caucasians living in the West, the most important causes are:

Malabsorption due to intestinal disease, for example after extensive small-bowel resection, treated and untreated Crohn's disease, and untreated coeliac disease.

Renal disease. In chronic renal failure, conversion of vitamin D to its active metabolite (1,25-dihydroxyvitamin D3) by renal tubular epithelial cells is impaired, and osteomalacia is one of the important metabolic bone diseases associated with renal failure.

Rarely, liver disease and some drug therapies may interfere with vitamin D metabolism and have a role in the development of osteomalacia.
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