Who gets osteomalacia?
Anyone who’s lacking vitamin D is likely to develop osteomalacia. Although we can get vitamin D from foods, most of our supply of vitamin D is produced by the body itself. Cholesterol, which is present naturally in the skin, is converted to vitamin D through the action of sunlight on the skin.
The people most at risk of osteomalacia are those who aren’t able to produce enough vitamin D through exposure to sunlight because:
- they're too frail or ill to go outside
- they wear clothing that covers almost all of the skin, for example, for religious reasons
- they have dark skin and live in parts of the world where the sunlight isn't very strong - dark skin is protective against intense sunlight but in cooler climates may be less efficient as a source of vitamin D.
Some people from Asia, particularly from the Indian sub-continent and surrounding region, are particularly at risk of osteomalacia. We don't yet know why this is the case, but it's likely to be due to a combination of factors. The skin of people from this region doesn't absorb vitamin D as well in cooler climates, and women who wear clothes that cover all their skin for religious reasons (such as a burka) will expose their skin less to direct sunlight.
Some foods commonly used in Asian diets are poor in vitamin D, and there may be chemicals within the diet which prevent vitamin D absorption - for example it's thought that chapatti flour may prevent the normal absorption of calcium from the stomach, though some chapatti flours now have vitamin D added to help calcium absorption.
Many people from the Indian sub-continent and surrounding region are lactose intolerant and so they may not be absorbing enough calcium.
People whose diet is lacking in vitamin D and/or calcium may be at risk, especially if they're also unable to produce enough vitamin D in their skin.