What Does Scurvy Do to the Bones? The Severe Skeletal Consequences of Vitamin C Deficiency

October 14, 2025 •

5 min read

Scurvy is a nutritional disease that arises from defective collagen synthesis, a process heavily reliant on adequate vitamin C levels. This impairs the structural integrity of connective tissues throughout the body, including the skeleton, leading to painful and destructive consequences for bones.

Quick Summary

Vitamin C deficiency cripples collagen formation, resulting in fragile bones, widespread pain, hemorrhaging under the bone's surface, and generalized osteoporosis. These severe skeletal complications are particularly damaging to the growing bones of children.

Key Points

Collagen Disruption: Scurvy's primary impact on bones is the result of defective collagen synthesis, as vitamin C is a crucial cofactor for forming strong collagen fibers.
Weakened Structure: The poorly formed collagen leads to fragile, brittle bones, resulting in generalized osteopenia and osteoporosis.
Painful Hemorrhage: Weakened blood vessels and periosteum cause subperiosteal hemorrhages, which are collections of blood under the bone membrane that cause severe pain and swelling, especially in long bones.
Growth Plate Abnormalities: In children, scurvy disrupts endochondral ossification, leading to distinctive radiographic signs at the metaphysis, such as the Frankel line and the Trümmerfeld zone.
Increased Fracture Risk: Due to overall bone fragility and microfractures, scurvy patients are at a higher risk of sustaining fractures, including compression fractures of the spine in adults.
Dental Decay: Impaired collagen synthesis also affects dentine, leading to loose teeth and weakened support structures.
Reversible Damage: Bone damage from scurvy is reversible with vitamin C supplementation, though healing times can vary.

Scurvy, a once-feared disease of sailors and the malnourished, results from a severe deficiency of vitamin C (ascorbic acid). Though rare in the modern era, cases still occur, particularly among vulnerable populations with limited dietary intake. While known for its effects on gums and skin, scurvy's impact on the skeletal system is profound and debilitating. The root cause lies in vitamin C's essential role in producing and stabilizing collagen, the fundamental protein providing strength and structure to bones, cartilage, and other connective tissues. Without sufficient vitamin C, the collagen matrix becomes weak and poorly formed, precipitating a cascade of bone problems, including intense pain, hemorrhaging, and increased fracture risk.

The Core Mechanism: Impaired Collagen Synthesis

Vitamin C acts as a vital cofactor for two key enzymes, prolyl hydroxylase and lysyl hydroxylase, which are responsible for adding hydroxyl groups to proline and lysine residues in collagen. This hydroxylation is a critical step for allowing the collagen fibers to cross-link and form the stable, strong triple-helical structure necessary for healthy bones and connective tissue. When vitamin C is lacking, this process is interrupted, and the resulting collagen is unstable and weak.

Beyond collagen synthesis, modern research reveals that vitamin C has other important functions in bone metabolism. A 2022 study in Nature Communications showed that vitamin C also has epigenetic functions, helping to orchestrate osteogenic (bone-forming) differentiation by modulating gene expression patterns. This suggests that scurvy's skeletal manifestations are not only due to defective collagen but also to broader issues with bone cell fate and function.

The Devastating Effects of Scurvy on Bones

Generalized Weakness and Pain

Osteopenia and Osteoporosis: Without a robust collagen framework, bone mineral density decreases, leading to osteopenia (low bone mass) and eventually osteoporosis. Radiographs of scurbutic bone show a characteristic 'ground-glass' appearance due to the loss of trabeculae.
Severe Bone Pain: One of the most common and distressing symptoms of scurvy is severe bone and joint pain, which can be mistaken for other conditions like juvenile rheumatoid arthritis or osteomyelitis. The pain arises primarily from subperiosteal hemorrhages but is exacerbated by the fragile, brittle nature of the bones.

Hemorrhage and Fractures

Subperiosteal Hemorrhage: This is a hallmark feature of advanced scurvy. Weakened blood vessel walls, combined with fragile periosteum (the membrane covering the outer surface of bones), cause bleeding to occur beneath the periosteum, particularly at the ends of long bones. This accumulation of blood causes intense pain and swelling, sometimes so severe that it results in 'pseudoparalysis' as the person is reluctant to move the affected limb.
Brittle Bones and Fractures: The defective bone matrix makes bones weak and susceptible to fracture from minimal trauma. This includes microscopic fractures that occur within the bone tissue itself, as well as more significant breaks. Spinal compression fractures have been reported in adult scurvy patients with severe osteoporosis.

Specialized Impacts on Growing Bones

In children, scurvy has additional, specific impacts on bone growth and development, which are often visible on radiographs. The condition primarily affects the growth plates (physes), leading to recognizable radiologic findings.

Disruption of Endochondral Bone Formation: Vitamin C deficiency disrupts the normal process of bone lengthening at the growth plate, where cartilage is converted into bone.
Classic Radiological Signs: Radiologists use several key signs to identify scurvy in children, including:
- White Line of Frankel: An irregular, thickened line at the metaphysis (the end of the bone shaft), representing the excessively calcified but defective cartilage.
- Trümmerfeld Zone: A transverse radiolucent band directly below the Frankel line, where the fragile, new bone has been fractured or resorbed.
- Wimberger Ring Sign: A ring of increased density that appears around the epiphyseal ossification centers, caused by the contrast between the calcified ring and the surrounding osteopenic bone.

Impact on Oral and Dental Health

Scurvy's effect on bone also extends to oral and dental health, as teeth are held in place by bone and connective tissue. Defective dentin formation can cause teeth to loosen and eventually be lost. Bleeding and swelling of the gums, common symptoms of scurvy, are also a consequence of weakened collagen in the soft tissues supporting the teeth.

Comparison of Scurvy's Bone Effects in Adults and Children


Feature	Adults with Scurvy	Children with Scurvy (Infantile Scurvy)
Primary Bone Issue	Widespread osteoporosis and increased fragility leading to fractures.	Disruption of endochondral bone formation at the growth plates.
Bone Pain	Aching pain in bones, muscles, and joints, especially at night.	Intense leg pain and tenderness due to subperiosteal hemorrhages, sometimes causing 'pseudoparalysis' and refusal to walk.
Radiological Findings	Generalized osteopenia is the most common feature. Vertebral fractures may also occur.	Distinctive features like the Frankel line, Trümmerfeld zone, and Wimberger ring sign at the end of long bones.
Fracture Location	Can occur in the spine or other osteoporotic areas.	Most common in the metaphysis or epiphyseal-metaphyseal plate, sometimes leading to epiphyseal separation.
Oral Health	Swollen, bleeding, and spongy gums; loose teeth.	Poor dentine formation and gum bleeding; loosening of teeth.

Diagnosis and Treatment

Diagnosing scurvy often begins with a high index of suspicion based on a patient's dietary history, especially in those with restricted eating patterns (e.g., due to neurodevelopmental disorders, alcoholism, or food insecurity). A physical examination may reveal classic symptoms like perifollicular hemorrhages and gum disease. Radiographic imaging can further support the diagnosis by revealing the characteristic bone changes.

The treatment for scurvy is straightforward and highly effective: vitamin C supplementation. Oral or intravenous ascorbic acid quickly replenishes the body's stores. The symptomatic improvement is often dramatic and rapid. For instance, bone and muscle pain can abate within days. However, full radiographic healing can take much longer, and ongoing nutritional counseling is crucial, particularly for those with chronic restrictive eating habits.

For more information on the diagnostic process and treatment protocol, consult resources like the National Institutes of Health(https://pmc.ncbi.nlm.nih.gov/articles/PMC10296835/).

Conclusion

Scurvy inflicts profound damage on the skeletal system by compromising the body's ability to produce stable, healthy collagen. This leads to a loss of bone mineral density, increased fragility, and painful, debilitating hemorrhages beneath the periosteum. The effects are particularly severe and distinct in growing children, with characteristic radiographic findings at the growth plates. However, because scurvy is primarily a nutritional deficiency, its skeletal manifestations are highly treatable with prompt and consistent vitamin C supplementation. Ultimately, understanding how scurvy destroys bone highlights the critical importance of a balanced, vitamin C-rich diet for maintaining strong, healthy bones throughout life.

Frequently Asked Questions

A vitamin C deficiency severely impairs the body's ability to synthesize and stabilize collagen, a primary component of the bone matrix. This leads to a loss of overall bone density, a condition known as osteopenia or osteoporosis, which makes bones weak and fragile.

Yes, severe and often excruciating bone pain is a common symptom of scurvy. It is typically caused by bleeding that occurs beneath the periosteum, the membrane covering the bone's surface. This subperiosteal hemorrhage creates painful pressure and swelling.

Yes, subperiosteal hemorrhage is a classic manifestation of scurvy, particularly in infants and children. It involves bleeding under the membrane that covers the bones, leading to swelling, tenderness, and intense pain.

In children, scurvy disrupts endochondral bone formation at the growth plates (physes). This leads to characteristic radiographic abnormalities like the 'Frankel line,' 'Trümmerfeld zone,' and 'Wimberger ring sign,' indicating weakened and disrupted growth plate structures.

The 'ground-glass' appearance refers to the translucent, hazy look of bones on an X-ray in a person with scurvy. It is a sign of generalized osteopenia, or low bone mineral density, caused by the loss of the normal trabecular bone pattern.

Yes, scurvy significantly increases the risk of fractures. The compromised collagen matrix makes bones brittle and fragile, meaning they can break easily from even minor trauma. This includes microscopic fractures and larger breaks.

Bone damage from scurvy is treated with vitamin C replacement therapy, administered orally or intravenously. With proper and prompt supplementation, many symptoms like pain can resolve quickly, although the full healing of bone abnormalities, visible on radiographs, can take longer.

Yes, while pediatric cases may have more dramatic growth plate effects, adults can also develop scurvy-related bone problems, including osteoporosis, bone pain, and an increased risk of fractures.