Rickets

Rickets is a bone disease most commonly caused worldwide by a deficiency of vitamin D. The deficiency may be caused by a lack of vitamin D in the diet, a lack of exposure to sunlight, or a problem the body has with absorbing or using vitamin D. If left untreated, rickets results in bone deformities.

What Is Vitamin D?

Vitamin D is a nutrient essential for proper bone formation. It helps regulate the amount of calcium and phosphorus in the blood, and these minerals are important components of bone formation. Vitamin D is called the “sunshine vitamin” because it is formed naturally in the skin in the presence of the ultraviolet * (UV) rays found in sunlight. Vitamin D can also be obtained from food. Vitamin D is added to milk and infant formula * , and egg yolks, liver, cod-liver oil, and other fish oils are good dietary sources of vitamin D.

What Is Rickets?

Rickets is characterized by improper hardening of the bones, resulting in skeletal deformities if left untreated. Rickets affects primarily infants and children because bone growth occurs during childhood. Rickets can occur for a number of reasons.

Nutritional childhood rickets

Rickets can occur because of a nutritional deficiency in vitamin D. In modern times this type of rickets is rare in developed countries. Children growing up in poor communities where vitamin D–rich foods may be scarce are the most susceptible to rickets. Children living in areas where there is a lack of sunshine, such as in the Northern Hemisphere in the winter, are also susceptible. Overcast and polluted atmospheres that block out the sun can also deprive children of vitamin D. Another form of nutritional rickets is seen in extremely premature babies if they are fed a vitamin D–poor formula or if their diet contains inadequate amounts of phosphorus and calcium.

Genetic childhood rickets

Rickets also can occur due to inherited genetic disorders that result in improper absorption or use of vitamin D, calcium, or phosphorus. In the United States, the most common cause of rickets is a disease called familial hypophosphatemia (hy-po-fos-faTEE-me-uh), which means “too little phosphorus in the blood.” In this genetic disease, phosphorus “leaks” out of the body through the kidneys. However, fewer than 10 out of every 1 million babies are affected by this disease.

Adult rickets

Adult rickets, or osteomalacia (os-te-o-ma-LAY-sha), causes bone problems similar to those found in childhood rickets. Osteomalacia can be caused by a nutritional deficiency of vitamin D, but it most commonly occurs when the body has problems absorbing phosphorus and calcium due to other illnesses (such as liver and kidney disease). In some instances, drugs that interfere with absorption of vitamin D cause rickets and osteomalacia.




Rickets can cause bone deformities. If it begins before a person learns to walk, the spine may become abnormally curved. If it begins or continues after the person starts to walk, the legs may become bowed by the weight of the body.





Rickets can cause bone deformities. If it begins before a person learns to walk, the spine may become abnormally curved. If it begins or continues after the person starts to walk, the legs may become bowed by the weight of the body.
Alila Medical Media/Shutterstock.com.

What Are the Symptoms of Rickets?

Children with rickets may not have any symptoms, or they may feel pain and develop bone deformities. A child who has or is developing rickets may experience muscle cramps, twitches, and abnormal contractions of the hands and feet due to low levels of calcium in the blood. The muscles, limbs, and abdomen grow weak, and the bones of the skull remain soft. An infant with rickets may have difficulty developing such basic movement skills as sitting, crawling, and walking due to weakness and pain.

A VITAMIN D TIMELINE

During the 1700s, cod-liver oil and sunlight were recognized as effective treatments for rickets.

By 1918, scientists had discovered vitamins. Experiments on animals showed that cod-liver oil had a vitamin that helped prevent rickets.

By 1924, ultraviolet (UV) light was used for treating rickets. The process was called irradiation. Researchers understood that vitamin D was formed by the effects of ultraviolet rays on the skin.

During 1930 and 1931, scientists in England and Germany were able to produce pure vitamin D for the first time.

Osteomalacia can cause similar effects: soft bones, skeletal pain, muscular weakness, and susceptibility to fractures.

How Is Rickets Diagnosed and Treated?

Rickets can be diagnosed with blood tests, in which the amounts of calcium, phosphorus, and vitamin D are measured, and with x-rays. Nutritional rickets is treated with dietary supplements of vitamin D and calcium. If treated early enough, there will be no long-lasting effects. If untreated, a child may develop permanent bone deformities. Dietary supplements of vitamin D, calcium, and phosphate also may be prescribed for people with rickets caused by other diseases or by genetic defects.

How Is Rickets Prevented?

Rickets can be prevented by consuming a diet rich in vitamin D as well as by spending time in the sun. A good source of vitamin D is vitamin D–fortified milk.

See also Broken Bones (Fractures) • Dietary Deficiencies • Growth and Growth Disorders • Kidney Disease

Resources

Books and Articles

O'Riordan, Jeffrey L. H., and Olav L. M. Bijvoet. “Rickets before the Discovery of Vitamin D.” BoneKEy Reports. January 2014. http://www.nature.com/bonekeyreports/2014/140108/bonekey2013212/full/bonekey2013212.html (accessed November 16, 2015).

Telford, Lyndsey. “Video Games Linked to Return of Rickets among Children.” The Telegraph. April 19, 2015. http://www.telegraph.co.uk/news/health/11548378/Video-games-linked-to-return-ofrickets-among-children.html (accessed August 12, 2015).

Websites

American Academy of Orthopaedic Surgeons. “Rickets.” http://orthoinfo.aaos.org/topic.cfm?topic=a00577 (accessed November 16, 2015).

MedlinePlus. “Rickets.” U.S. National Library of Medicine, National Institutes of Health. http://www.nlm.nih.gov/medlineplus/rickets.html (accessed August 12, 2015).

National Organization for Rare Disorders. “Rickets, Vitamin D Deficiency.” https://rarediseases.org/rare-diseases/rickets-vitamin-d-deficiency/ (accessed November 16, 2015).

NHS Choices. “Rickets.” National Health Services. (accessed August 12, 2015).

Vitamin D Council. “Rickets.” https://www.vitamindcouncil.org/health-conditions/rickets/ (accessed November 16, 2015).

Organizations

American Academy of Orthopaedic Surgeons. 9400 West Higgins Rd., Rosemont, IL 60018. Telephone: 847-823-7186. Website: http://www.aaos.org (accessed November 16, 2015).

National Organization for Rare Disorders. 55 Kenosia Ave., Danbury, CT 06810. Telephone: 203-744-0100. Website: https://rarediseases.org (accessed August 12, 2015).

Vitamin D Council. 1241 Johnson Ave. #134, San Luis Obispo, CA 93401. Telephone: 805-439-1075. Website: https://www.vitamindcouncil.org (accessed November 16, 2015).

World Health Organization. Avenue Appia 20, 1211 Geneva 27, Switzerland. Telephone: 41-22-791-21-11. Website: http://www.who.int (accessed August 12, 2015).

* ultraviolet is a wavelength of light beyond visible light; on the spectrum of light, it falls between the violet end of visible light and x-rays.

* formula is a prepared, nutritious drink or a dry drink mix designed

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)