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Last updated July 9, 2017, originally published June 9, 2015

By Louise Carr, Associate Editor and Featured Columnist

[Health and fitness articles are reviewed by our team of
Doctors, Registered Nurses, Certified trainers and other
members of our Editorial Board.]

Do you suffer from a dull, achy pain in your legs, ribs, or
back that sometimes gets worse at night? Do you waddle
when you walk? What about muscle weakness? Are you
finding it increasingly difficult to get around?

If so, you could be suffering from soft bones. Soft bones,
also known as "osteomalacia", is associated with Vitamin D
deficiency. A shocking 40 percent of the US population is
estimated to be
Vitamin D deficient, according to the National
Health and Nutrition Examination Survey 2005 to 2006, and
are at risk of suffering from soft bones.

When you have soft bones they are more likely to break and
bend than healthy, harder bones. Fortunately there are
strategies to strengthen soft bones. What can you do about
soft bones and how can you do it?

Soft Bones, Osteoporosis, and Rickets

Osteomalacia --- soft bones --- is not the same as
osteoporosis, although both are bone disorders that can lead
to fractures.

Osteomalacia occurs following a defect in the bone-building
process, while osteoporosis happens when previously built
bone weakens. To build bones, your body relies on adequate
supplies of Vitamin D, as well as phosphate and calcium.

In children, soft bones is called "rickets", a disease that
seems too old-fashioned to be relevant today.

Think we've conquered rickets? Think again. Severe vitamin
D deficiency was common in the UK in the 1800's when coal
smoke from factories blocked the sun, causing a high
incidence of rickets in children.

But even today in the US, it is estimated that five children per
million have rickets (Centers for Disease Control and
Prevention) – not a huge number, perhaps, but nutritional
rickets was supposedly eradicated in the 1930's so even this
figure is too high. Among adults, too few of us get enough
sun exposure, especially as we age, when many of us spend
too many hours indoors, even on beautiful sunny days.

What Causes Soft Bones?

Strong bones come from calcium and phosphate, which the
body uses to build bone. If you don’t get enough of these
minerals or your body fails to absorb them, your bones could
become soft. The major cause of a lack of calcium in the
bones is vitamin D deficiency.

Vitamin D is unique as it is both a vitamin and a hormone. It
is a vitamin because your body needs it to absorb calcium. It
is a hormone because it is manufactured as a response to
sunlight. If you do not get enough sunlight or Vitamin D
from supplements, your bones become soft.

You may suffer from a
Vitamin D deficiency after surgery to
remove parts of your stomach, or if you suffer from
disease. Certain kidney or liver disorders, and some drugs to
prevent seizures, affect the processing of Vitamin D.

What Are the Symptoms of Soft Bones?

In the early stages, you are unlikely to experience any
symptoms associated with soft bones. But as the condition
worsens you may suffer from bone pain and muscle

Bone pain is a dull, aching pain and most commonly affects
the pelvis, hips, back, legs, and ribs.

You may experience worse pain at night or when you put
weight on the affected bones.

Do you waddle? As bone softening progresses, the lack of
muscle tone and weakness around the bones in the legs
causes you to waddle when walking. You'll find it hard to get

Treating soft bones involves replenishing lost stocks of
Vitamin D and calcium, and keeping the levels high in the
body. We looked at the scientific evidence to see how to
make this happen.

Spend Enough Time in the Sun to Help Soft Bones  

By far the most efficient way to get good levels of Vitamin D,
which prevents soft bones, is to spend time in sunlight.
Studies show that people who are sunlight-deprived are
more likely to be Vitamin D deficient.  


Getting enough sunlight depends on three factors: where
you live, your skin color and how long you stay in the sun. If
you live near the Equator or south of Virginia, and if you are
fair-skinned, getting enough sun is relatively easy. Simply
stay exposed to the sun outdoors for about half the amount
of time it takes for you to tan.  The darker you are and the
farther north you live, the less likely you are to be able to get
enough sun simply from sunlight. You will need to consider
Vitamin D supplements, especially during the winter months.]

The risk of soft bones is highest in people who have both an
inadequate dietary intake of Vitamin D and low levels of
exposure to sunlight, such as the elderly or people in
hospital, according to a 1995 study from Union Memorial
Hospital, Baltimore.

And a 2009 study from the University of Melbourne,
Australia showed that adults spending time in Antarctica
without adequate sunlight exposure developed vitamin D
insufficiency. While a 2000 study from the University Hospital
of Aarhus, Denmark into veiled Arab women demonstrated
that the commonly recommended daily intake of Vitamin D
was not sufficient when sunlight exposure was limited.

But Don’t Spend Too Much Time in the Sun

Although a lack of exposure to sunlight is linked to soft
bones, it is not wise to go too far the other way and spend a
lot of time in the sun without sun protection because you
risk skin cancer and sun burn.

So how much is enough sun?

In a 2005 study from the Naval Submarine Medical Research
Laboratory, Groton, CT, six days of sunlight exposure
proved enough to make up for 49 sunless days, but experts
are not in agreement as to how many minutes it takes a day
to get enough Vitamin D to prevent soft bones.

Besides, where you live, the strength of the sun, and your
habits such as covering up or wearing minimal clothes, affect
how much Vitamin D your skin gets from the sunlight.

Watch Out for the “Vitamin D Winter” – You Risk Soft

The latitude at which you live affects how well your skin can
convert sunlight into Vitamin D, particularly during the
winter when Vitamin D deficiency and soft bones become a
real risk.

The “Great Divide” between those who live above and those
who live below the 37 degree latitude line influences the
frequency of Vitamin D deficiency.

In a 1998 study from Boston University Medical School, for
example, exposure to winter sunlight in Boston and
Edmonton will not promote Vitamin D synthesis in skin. The
sun is just too weak there.

Northern latitudes affect the quantity and quality of solar
radiation reaching earth. In Edmonton, the ineffective
Vitamin D winter lasts from October through March, while in
Boston no Vitamin D is produced from the sun between
November and February.

What states are above the 37 degree latitude divide? Any
state above Tennessee, Oklahoma, or New Mexico lies too far
North for adequate winter sunlight. In California , the 37th
degree line crosses in about the middle of the state.

Further south, there is no such Vitamin D winter.

For this reason, scientists recommend Vitamin D
Supplementation is advised for people living in northern
latitudes during the winter, no matter how much time they
spend outdoors.

Eat Foods High in Vitamin D to Prevent Soft Bones?

The best way to get Vitamin D from food is by eating
breakfast cereals and other products that have Vitamin D
added.  In the US, milk is often fortified with Vitamin D.

That’s because there is very little Vitamin D found naturally
in food. The best source is oily fish (sardines, salmon,
mackerel) and egg yolks. Mushrooms, cheese, and beef liver
have small amounts of Vitamin D. If your diet is full of these
kinds of foods then you are less likely to suffer from soft

Take Calcium and Vitamin D Supplements to Prevent Soft

Given that it is hard to get Vitamin D from food and that
often, depending where you live, you may not get it from the
sun, supplementation is often a good idea to prevent soft

And supplementation with a combination of calcium and
Vitamin D is the best, according to experts.

The combined force of the two nutrients helps prevent soft
bones, says research such as a 1997 report from the Human
Nutrition Research Center on Aging at Tufts University,

As a Last Resort, Cod Liver Oil Helps Stop Soft Bones

Cod liver oil was popular among families in the 1800s to
prevent rickets. It is high in Vitamin D but has largely fallen
out of fashion, mainly due to the unappetizing taste and

If you do decide to get your Vitamin D from cod liver oil, be
careful that you are not exceeding your maximum intake of
either Vitamin D or Vitamin A. Excess levels of these vitamins
build up in your body as they are fat soluble.  

Combat Celiac Disease to Help Mend Soft Bones

One way in which Vitamin D status is compromised is
through the digestive system.

People with Celiac disease, where the lining of the small
intestine is routinely damaged when you eat foods
containing gluten, often fail to absorb properly Vitamin D,
which leads to soft bones. Making changes to your lifestyle
such as avoiding problematic foods can help your bones as
well as your digestive health.

Even those of us without Celiac disease may have intestines
that cannot properly absorb Vitamin D. Leaky gut syndrome
occurs when the intestines become porous, possibly because
of gluten sensitivity. Gluten, the protein found in wheat, rye
and barley, can punch a hole in your intestinal wall. As a
result, your gut "leaks" vitamins and nutrients. If you have a
leaky gut, you will need to increase the levels of Vitamin D
you intake, just to make up for the leaking.]

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The best remedy for soft bones i s
to get enough sun.