Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones.
Causes
- Lack of vitamin D or calcium
- Genetic defect
Hypophosphatemic rickets involves a genetic defect that causes abnormalities in the way the kidneys and bones deal with phosphate.
- Underlying disease
Rickets occasionally develops in children with rare forms of kidney, liver and gut diseases that affect the absorption and metabolism of vitamins and minerals.
- Northern latitudes
Children who live in geographical locations where there is less sunshine are at higher risk of rickets.
- Premature birth
- Anti-seizure medications
- Exclusively breastfed.
Symptoms and signs of Rickets
Bone pain or tenderness in
- Arms
- Legs
- Pelvis
- Spine
Dental deformities
- Delayed formation of teeth
- Decreased muscle tone
- Defects in the structure of teeth; holes in the enamel
- Increased cavities in the teeth
- Progressive weakness
- Impaired growth
- Increased bone fractures
- Muscle cramps
Skeletal deformities
- Asymmetrical or odd-shaped skull
- Bow legs
- Rachitic rosary
- Pigeon shaped chest
- Pelvic deformities
- Spine deformities (scoliosis or kyphosis)
Investigations
- ALP (alkaline phosphatase) isoenzyme
- Arterial blood gases
- Blood tests (serum calcium)
- Bone biopsy (rare)
- Bone x-rays
- Calcium (ionized)
- PTH
- Serum alkaline phosphatase
- Serum phosphorus
- Urine calcium
Treatment
- In case of dietary deficiency or a lack of sun exposure —
- Daily calcium and vitamin D supplements
- Eating more calcium-rich food (with caution as high calcium doses can lead to hypercalcaemia)
- In the case of hypophosphatemic rickets – A combination of phosphate supplements and a special form of vitamin D
- If there is a kidney disease, patients with rickets may require dialysis.
- In case of bone deformity – A special brace to position the child’s body appropriately as their bones grow
Complications
- Bone fractures
- Dental defects
- Failure to grow
- Pneumonia
- Seizures
- Skeletal deformities
Prevention
Diet
- Sources of vitamin D
- oily fish
- liver
- eggs
- margarine
- breakfast cereals with added vitamin D
- Sources of calcium
- dairy products( milk, cheese and yoghurt)
- green vegetables (broccoli and spinach)
- wholemeal bread
- dried fruits
- beans and pulses, such as lentils
Sunlight
It is a natural Source of Vitamin D.
- Supplements (Vitamin D and Calcium)