The total bone mass may be normal or increased. Osteoporosis on the other hand is characterized by preservation of mineralized bone. Inadequate exposure to sunlight and poor dietary intake are usually necessary for clinical vitamin D deficiency to develop. In adults the manifestations of osteomalacia are subtle. The clinical manifestations of rickets are the result of skeletal deformities.
Patients are susceptible to fractures, weakness, hypotonia and disturbances in growth.
The presentation of osteomalacia in adults is usually not as dramatic as in infants and children. Many of the skeletal deformities are often overlooked. Diffuse skeletal pain and bony tenderness are the major symptoms patients report. The bone pain is a hallmark of osteomalacia. It may be generalized or localized to the vertebrae, hips, pelvis, ribs, or lower extremities.