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What is Rickets?
Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency.
Vitamin D promotes the absorption of calcium and phosphorus from the gastrointestinal tract. A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in bones, which can cause rickets.
If a vitamin D or calcium deficiency causes rickets, adding vitamin D or calcium to the diet generally corrects any resulting bone problems for your child. Rickets due to a genetic condition may require additional medications or other treatment. Some skeletal deformities caused by rickets may need corrective surgery.
Rickets Facts
- Rickets is a bone disorder caused by a deficiency of vitamin D, calcium, or phosphate.
- There are several different types of rickets.
- There are different bony abnormalities associated with rickets, but all are due to poor mineralization with calcium and phosphate.
- The active form of vitamin D is synthesized by skin cells when exposed to sunlight.
- Vitamin D is found in small amounts in some foods.
- Infants who are exclusively breastfed should receive vitamin D supplements.
- Children and adolescents who do not obtain enough vitamin D though milk and foods should receive vitamin D supplements
Causes of Rickets
Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones. This leads to weak and soft bones.
Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D production by the skin may occur in people who:
- Live in climates with little exposure to sunlight
- Must stay indoors
- Work indoors during the daylight hours
You may not get enough vitamin D from your diet if you:
- Are lactose intolerant (have trouble digesting milk products)
- Do not drink milk products
- Follow a vegetarian diet
Infants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D. This can be a particular problem for darker-skinned children in winter months (when there are lower levels of sunlight).
Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in diet is rare in developed countries, because calcium and phosphorous are found in milk and green vegetables.
Your genes may increase your risk of rickets. Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis.
Disorders that reduce the digestion or absorption of fats will make it more difficult for vitamin D to be absorbed into the body.
Occasionally, rickets may occur in children who have disorders of the liver, or who cannot convert vitamin D to its active form.
Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth, when the body needs high levels of calcium and phosphate. Rickets may be seen in children ages 6 – 24 months. It is uncommon in newborns.
Symptoms of Rickets
Symptoms of rickets include:
- pain or tenderness in the bones of the arms, legs, pelvis, or spine
- stunted growth and short stature
- bone fractures
- muscle cramps
- teeth deformities, such as:
- delayed tooth formation
- holes in the enamel
- abscesses
- defects in the tooth structure
- an increased number of cavities
- skeletal deformities, including:
- an oddly shaped skull
- bowlegs, or legs that bow out
- bumps in the ribcage
- a protruding breastbone
- a curved spine
- pelvic deformities
Call your doctor right away if your child is showing signs of rickets. When the disorder isn’t treated during a child’s growth period, the child may end up with a very short stature as an adult. Deformities can also become permanent if the disorder goes untreated.
Risk factors for Rickets
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Risk factors for rickets include:
- Poverty – rickets is more likely to occur among children who are poor.
- Sunlight – children who do not get enough sunlight are more dependent on excellent 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.
Who’s affected with Rickets
Rickets was common in the past, but it mostly disappeared in the western world during the early 20th century after foods like margarine and cereal were fortified with vitamin D.
However, in recent years, there’s been an increase in cases of rickets in the UK. The number of rickets cases is still relatively small less than 700 cases were diagnosed in hospitals in England in 2013-14 but studies have shown a significant number of people in the UK have low levels of vitamin D in their blood.
Any child whose diet doesn’t contain enough vitamin D or calcium can develop rickets, but the condition is more common in children with dark skin, as this means they need more sunlight to get enough vitamin D, as well as children born prematurely or taking medication that interferes with vitamin D.
Treatment for Rickets
The treatment for rickets depends upon the cause as mentioned above in the discussion of hypophosphatemic rickets and renal rickets. In cases of nutritional rickets and vitamin D deficiency, treatment is simple. The first step is to prevent the complications of calcium and phosphate deficiency by correcting any abnormal levels with supplemental calcium or phosphate as well as the activated vitamin D (calcitriol). Once the diagnosis of rickets is confirmed, initiation of vitamin D supplementation is recommended, as well as a diet rich in calcium. This is especially important for children on vegan diets. The treatment for some of the bony abnormalities depends on the severity of the cases and may require referral to an orthopedic provider for evaluation.
