What is Rickets?
Rickets is the softening and weakening of bones which usually manifests as bending of bones in children. It occurs because of an extreme and prolonged vitamin D deficiency. Some inherited problems also can cause rickets.
What exactly happens in Rickets?
Vitamin D helps the body to absorb calcium and phosphorus from food. Deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in bones, which causes softening and bending of bones (Rickets).
What are the causes ?
- Not enough vitamin D in the diet (Mother suffering from vitamin D deficiency)
- Malabsorption of vitamin D by the intestines
- Genetic/inherited causes
- Excessive excretion of phosphorus through urine (Rare)
Symptoms
Signs and symptoms of rickets are:
- Delayed growth
- Delayed motor skills
- Pain in the spine, pelvis and legs
- Muscle weakness
Because rickets softens the areas of growing tissue at the ends of a child’s bones (growth plates), it can cause skeletal deformities such as:
- Bowed legs or knock knees
- Thickened wrists and ankles
- Breastbone projection (Pectus carinatum)
What are the tests to be done?
Blood tests:
Calcium, Phosphorus, alkaline phosphatase, creatinine and 25 hydroxy vitamin D3 levels.
Bone x-rays:
Most important in the diagnosis of rickets. It will show widening of the epiphysis, cupping, fraying and splaying of the metaphyses.
What is the treatment ?
Treatment involves oral vitamin D and calcium supplements.
Dosing scheme recommended for treatment of vitamin D deficient rickets:
Age Group
Recommended Daily Dose
Newborns < 1 month
1000 IU
Infants 1–12 months
1000–5000 IU
Children > 1 year
5000-10000 IU
Treatment is continued until there is radiographic evidence of healing; subsequently, the dose of vitamin D is reduced to 400 IU daily.
Calcium intake should be maintained at approximately 1000 mg/day (30–75 mg/ kg of elemental calcium per day in three divided doses).
Treatment leads to resolution of the biochemical and bone (radiological) abnormalities
within 3 months.
What is the prognosis?
Skeletal deformities regress completely after medical therapy. However, orthopedic intervention can be done if deformities do not improve even after radiologic appearance of the growth plates has normalized.