Rickets (osteomalacia)

• What is Rickets
• Statistics on Rickets
• Risk Factors for Rickets
• Progression of Rickets
• Symptoms of Rickets
• Clinical Examination of Rickets
• How is Rickets Diagnosed?
• Prognosis of Rickets
• How is Rickets Treated?
• Rickets References

What is Rickets

Rickets is a childhood afflicition of what is commonly known in adults as Osteomalacia. It is primarily caused by lack of vitamin D, calcium, or phosphate.

Statistics on Rickets

Incidence in Europe, US and Australia are rare in regards to nutritional Rickets due to Vitamin D qualtities in die, but it can occur however in high risk populations. In sunny areas, such as in the Middle East, rickets may occur when infants are bundled in clothing and are not exposed to sunlight. In some parts of Africa, deficiency of calcium and/or phosphorous in the diet may lead to rickets.

Risk Factors for Rickets

Vitamin D may be absorbed from food by the intestines or may be produced by the skin when the skin is exposed to sunlight. In its active form, vitamin D acts as a hormone to regulate calcium absorption from the intestine and to regulate levels of calcium and phosphate in the bones.

• Rickets Mild form continues in the high-risk population (eg, individuals with dark skin, persons who live in inner-city areas).
• Breastfed infants who receive no vitamin D supplementation are also at risk.
• Vitamin D is a fat-soluble vitamin, conditions that reduce digestion or absorption of fats will decrease the ability of vitamin D to be absorbed from the intestines.

How is Rickets Diagnosed?

• Alkaline phosphatase levels increased
• Blood calcium low
• Serum phosphate may be low owing to increased PTH dependent phosphaturia.
• Serum 25 hydroxyvitamin D3 – usually low

Prognosis of Rickets

The disorder may be corrected with replacemetn of the minerals the patient is deficient in. Laboratory results on sufferers usually improve significantly within the first week. However. some cases demonstrate a level of resistance to Vitamin D supplementation

How is Rickets Treated?

Prevention:

• Health education to ensure a balanced diet, adequate sunlight exposure and where appropriate in high risk individuals, dietary vitamin D supplementation. Managment:
• Treatment of the cause.
• Increase vitamin D from diet (and sunlight exposure). When deficiency is nutritional replacement doses are needed.
• Much higher pharmacological doses may be needed in patients with gastrectomy, malabsorption, liver disease or hypoparathyroidism.
• All patient receiving high doses of Vitamin D should have their serum calcium measured regularly.

Rickets References

1. Harrison HE, Harrison HC: Disorders of calcium and phosphate metabolism in childhood and adolescence. Philadelphia: WB Saunders Co. 1979.
2. Price DI, Stanford LC, Braden DS, et al: Hypocalcemic rickets: an unusual cause of dilated cardiomyopathy. Pediatr Cardiol 24(5): 510-2
3. Zmora E, Gorodischer R, Bar-Ziu J: Multiple nutritional deficiencies in infants from a strict vegetarian community. Am J Dis Child 1979; 133: 141.