Senior woman lifting hand weights with therapist

Metabolic bone disease comprises a spectrum of conditions that cause changes in structure and strength of the bones, usually due to mineral deficiencies and/or hormonal imbalances.

Deficiencies in essential bone elements, such as calcium, phosphorus and vitamin D, may be due to diet or changes in hormone levels, or they can be the result of a tumor or an another condition that affects mineral levels in the body.

Types of Bone Disease

At the UM Center for Diabetes and Endocrinology, our bone specialists diagnose and treat a range of conditions including:


Osteoporosis, the most common bone disease, is a thinning of the bones over time that increases the risk of fracture. Osteopenia is a less severe form of bone loss, which may precede osteoporosis.

Treatment focuses on slowing the loss of bone mass and rebuilding bones through medications and dietary changes.

Parathyroid Disease

Parathyroid hormones regulate the calcium and phosphorus levels in your blood. Too much or too little can cause an imbalance that can negatively affect your bone health or lead to other issues such as kidney problems.

The cause of abnormal parathyroid levels can be low vitamin D, conditions such as kidney failure and parathyroid tumors (both cancerous and non-cancerous).

Vitamin D Deficiency

Getting sufficient vitamin D is an important factor in keeping your bones strong. A vitamin D deficiency may cause muscle pain and/or weakness, fatigue and depression and can contribute to the development of osteoporosis.

A severe lack of vitamin D in children is known as rickets. In adults it's called osteomalacia. Rickets is rare in the United States now because many foods are fortified with vitamin D.

However, adults can develop osteomalacia due to troubles absorbing vitamin D from a variety of causes including:

  • Gastrointestinal procedures, such as bariatric surgery
  • Celiac disease
  • Kidney or liver disorders
  • Medications, such as steroids, anti-fungal and anti-seizure medicines

Paget's Disease of Bone

The body constantly recycles bone, replacing old bone tissue with new. In Paget's disease, errors in this recycling process can cause abnormalities that lead to arthritis, bone weakness, bone pain and/or fractures. Typically these occur in the pelvis, skull, spine and legs.

Metabolic Bone Disease Treatment

Treatments vary based on the specific type of bone disease. However, maintaining bone density is an important goal of any treatment plan.

The main way to determine your bone density is to have a painless, non-invasive bone density scan, called dual-energy X-ray absorptiometry (DEXA). The scan focuses on your hip and your spine and measures the mineral content and area of the bone.

At UM Center for Diabetes and Endocrinology, our team creates individualized plans that focus on treating the causes of bone disease as well as managing the symptoms that affect your well-being. This includes:

  • Medications – oral, IV infusion, injections
  • Lifestyle/nutrition coaching
  • Physical therapy
  • Fall prevention

Metabolic Bone Disease Specialists

Kashif M. Munir, MD

Kashif M. Munir, MD

Professor of Medicine, University of Maryland School of Medicine

Hilary Brooke Whitlatch, MD

Hilary Brooke Whitlatch, MD

Assistant Professor of Medicine, University of Maryland School of Medicine

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