The main cause of rickets is a lack of vitamin D. Also, not consuming enough calcium can cause rickets, as may vomiting, diarrhea, and liver diseases. Certain complications of digestive disorders can also cause rickets.
Rickets mainly affects children, but may also affect adults (osteomalacia). In most cases, the child has suffered from severe and long-term malnutrition, usually during early childhood.
Fast facts on rickets:
- The term rickets comes from the Old English word "wrickken," meaning to twist or bend. Rickets was common in the United Kingdom and United States during the 1800s.
- For proper absorption of calcium and phosphorous, we need vitamin D.
- Providing a child with extra vitamin D and some minerals usually resolves rickets.
Signs and symptoms of rickets
Signs and symptoms of rickets may include the following:
- Baby is 'floppy.'
- Bone pain.
- Bone tenderness.
- Bones break easily.
- Costochondral swelling - prominent knobs on the bone between the ribs and the breast plate.
- Harrison's groove - a horizontal line visible on the chest, where the diaphragm attaches to the ribs.
- Low calcium blood levels (hypcalcemia).
- Older children may have knock knees (genu valgum).
- Soft skull (craniotabes).
- Low physical growth (height and weight) may be affected.
- There may be spinal, pelvic, or cranial deformities.
- Toddlers may have bowed legs (genu varum).
- Uncontrolled muscle spasms, which may affect the entire body (tetany).
- Widening wrists.
Symptoms vary in severity and may be intermittent.
Causes of ricketsThere are several causes of rickets, including:
Lack of vitamin D
Eggs and oily fish, such as salmon, are excellent sources of vitamin D.
Our bodies need vitamin D in order to absorb calcium from the intestines. Ultraviolet light (from sunlight) helps our skin cells convert vitamin D from an inactive to an active state.
If we do not have enough vitamin D, calcium that we get from the food we eat is not absorbed properly, causing hypocalcemia (low levels of calcium in the blood).
Hypocalcemia results in deformities of bones and teeth, as well as neuromuscular (nerve and muscle) problems.
Adding vitamin D to a diet is relatively simple. The following foods are rich in vitamin D:
- fish oils
- some fortified milks and juices
- some oily fishes, including mackerel and salmon
- some soy milk products have vitamin D added
Vitamin D deficiency can easily be improved with small dietary changes, which makes the most common cause of rickets the most easily avoidable.
Hypophosphatemic rickets is a rare genetic fault that prevents the kidneys from processing phosphates properly. Low levels of phosphate in the blood lead to weak and soft bones.
Some kidney, liver, and intestinal diseases can interfere with the way the body absorbs and metabolizes minerals and vitamins, resulting in rickets.
Simply, treatment focuses on increasing the patient's intake of calcium, phosphates, and vitamin D. This may involve exposure to sunlight, consuming fish oils, and ergocalciferol or cholecalficerol (forms of Vitamin D).
Exposure to ultraviolet B light and consuming calcium and phosphorus is usually enough to reverse or prevent rickets.
If rickets is caused by bad diet, the patient should be given daily calcium and vitamin D supplements, an annual vitamin D injection, as well as being encouraged to eat vitamin D rich foods.
Treating genetic rickets - the patient will be prescribed phosphorus medications and active vitamin D hormones.
Other medical conditions - if rickets has an underlying medical cause, such as kidney disease, that disease needs to be treated and controlled.
Prevention of rickets
Getting adequate sunlight is an important way to prevent rickets.
Estimating the exact vitamin D needs of each human is very difficult, because it is hard to measure how much of the vitamin is synthesized in the skin via sunlight.
In countries that are not near the tropics and sunlight intensity is lower, it is important to provide a supplementary intake of vitamin D to prevent rickets.
This may involve:
- enriching milk, baby foods, and some other food products
- the administration of a daily vitamin D supplement
- massive doses of vitamin D when it is impossible for socioeconomic reasons to provide a vitamin supplement
In areas with a lot of sunlight, the best way to prevent rickets is to expose the child to the sun.
Risk factors and complications of rickets
Risk factors for rickets include:
- Poverty - rickets is more likely to occur among children who are poor because access to adequate nutrition may be limited.
- Sunlight - children who do not get enough sunlight are more dependent on good nutrition to make sure they are getting enough vitamin D.
- Malnutrition - rickets is more common in areas of the world where severe droughts and starvation occur.
Complications of rickets can occur:
- If left untreated, a child with rickets is more prone to fractures of the bone. If the rickets is severe and prolonged, there may be permanent bone deformities.
- Severely low blood calcium levels can lead to cramps, seizures, and breathing problems.
- Heart muscle weakness - this complication is rare.
How is rickets diagnosed?
The diagnosis of rickets is achieved in the following ways:
- Blood tests - measures levels of calcium and phosphorus. Levels of alkaline phosphatase may also be high.
- Arterial blood gases - checks how acidic the blood is.
- X-rays - these may reveal calcium loss in bones, or alterations in the structure or shape of the bones.
- Bone biopsy - this can confirm rickets (rarely used).
Physical symptoms of rickets, such as bowed legs or a soft skull, will also be checked; however, these are not reliable enough to use on their own.