Rickets is a childhood bone disorder where bones soften and become prone to fractures and deformity. It is rare in industrialized nations, but fairly common in some developing countries.

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.

Treatment focuses on providing nutrition. A study published in JAMA in 2013 suggested that infants should be given a daily dose of vitamin D to support bone mineralization.

Fast facts on rickets:

  • Rickets is a condition that most often occurs due to malnutrition.
  • Symptoms can include weak bones and bowed legs.
  • Providing a child with extra vitamin D and some minerals usually resolves rickets.
  • Rickets can also occur as the result of a genetic condition.

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Rickets causes weak or deformed bones during childhood.

Rickets is a disorder that often occurs during childhood in which the bones become weak and deformed.

It is a condition usually linked to malnutrition. The condition remains rare in the United States, but statistics on rickets have shown an increase in the number of people diagnosed since the year 2000.

The condition comes about due to a low intake of vitamin D, which means that low exposure to sunlight can also contribute.

Rickets mainly affects children, but may also affect adults in a condition known as osteomalacia. In most cases, the child has experienced severe and long-term malnutrition, usually since early childhood.

Signs and symptoms of rickets may include the following:

  • floppiness in the limbs of an infant
  • bone pain
  • bone tenderness
  • bones break easily
  • costochondral swelling, or prominent knobs on the bone between the ribs and the breast plate.
  • Harrison's groove, which is a horizontal line visible on the chest where the diaphragm attaches to the ribs
  • low levels of calcium in the blood
  • knock knees in older children
  • a soft skull
  • short height and low weight
  • possible spinal, pelvic, or cranial deformities
  • bowed legs in toddlers
  • uncontrolled muscle spasms that can affect the entire body
  • widening wrists

Symptoms vary in severity and may be intermittent.

Complications

Complications of rickets can occur, including:

  • If left untreated, a child with rickets is more prone to fractures of the bone. People with more severe and prolonged rickets may experience permanent bone deformities.
  • Severely low calcium levels in the blood can lead to cramps, seizures, and breathing problems.
  • In rare cases, rickets can weaken the heart muscles.

Lack of vitamin D

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Eggs and oily fish, such as salmon, are excellent sources of vitamin D.

The body needs vitamin D to absorb calcium from the intestines. The ultraviolet (UV) light in sunlight helps the skin cells convert vitamin D from an inactive to an active state.

If a person does not have enough vitamin D, calcium is not absorbed properly from the food they eat, causing low levels of calcium in the blood.

Low calcium levels result in deformities of bones and teeth, as well as nerve and muscle problems.

Adding vitamin D to a diet is relatively simple. The following foods are rich in vitamin D:

  • eggs
  • fish oils
  • margarine
  • 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.

Genetic defect

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 diseases

Some kidney, liver, and intestinal diseases can interfere with the way the body absorbs and metabolizes minerals and vitamins, resulting in rickets.

Risk factors

There are a few factors that greatly increase the risk of rickets, including:

  • Poverty: Rickets is more likely to occur among children who are poor because access to adequate nutrition may be limited.
  • Poor exposure to 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.

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Fish oil tablets are one way of treating rickets.

The treatment of rickets 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 cholecalciferol, which are both forms of Vitamin D. Exposure to UVB light and consuming calcium and phosphorus is usually enough to reverse or prevent rickets.

If rickets is caused by a poor diet, the patient should be given daily calcium and vitamin D supplements and an annual vitamin D injection, as well as being encouraged to eat vitamin-D-rich foods.

When treating rickets that has a genetic cause, the patient will be prescribed phosphorus medications and active vitamin D hormones.

If rickets has an underlying medical cause, such as kidney disease, that disease will need to be treated and controlled.

The diagnosis of rickets is achieved in the following ways:

  • Blood tests: These tests measure the levels of calcium and phosphorus. Levels of alkaline phosphatase may also be high.
  • Arterial blood gases: This test 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 but is 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. A positive indication of rickets from one of the above tests is also required for a rickets diagnosis.

Rickets can be prevented by consuming enough vitamin D.

Estimating the exact amount vitamin D needs of each human is 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, foods for infants, 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.

While exposure to sunlight is a good source of vitamin D, it is important not to overdo it - excess sunlight exposure can lead to sunburn and eventually skin cancer.