Rickets

Written by Jacquelyn Cafasso | Published on August 7, 2012
Medically Reviewed by Paul Rudd, MD

What is Rickets?

Rickets is a nutritional disorder that can develop if you do not get enough vitamin D, calcium, or phosphate. Rickets leads to poor functioning of a bone’s growth plate (growing edge), softened and weakened bones, stunted growth, and, in severe cases, skeletal deformities.

Vitamin D helps your body absorb calcium and phosphate from your intestines. You can get vitamin D from the foods you eat, such as milk, eggs, and fish, but your body also makes the vitamin when you’re exposed to sunlight.

A vitamin D deficiency makes it difficult for your body to maintain high enough levels of calcium and phosphate. When this occurs, your body releases hormones that cause calcium and phosphate to be released from your bones. When your bones lack these minerals, they become weak and soft.

Rickets is most common in children ages 6 to 24 months. Children are at the highest risk of rickets because they are still growing. Children might not get enough vitamin D if they live in a climate with little sunlight, have dark skin, do not drink milk products, or follow a vegetarian diet. In some cases, the condition is hereditary.

According to the National Institutes of Health (NIH), rickets is rare in the United States. Rickets used to be more common, but mostly disappeared in developed countries during the 1940s due to the introduction of fortified foods, such as cereals with added vitamin D (NIH).

Who Is at Risk for Developing Rickets?

Risk factors for rickets include the following:

Age

Rickets is most common in children during periods of rapid growth (ages 6 to 24 months). This is when their bodies need the most calcium and phosphate to strengthen and develop their bones.

Diet

You may be at a higher risk if you eat a vegetarian diet that does not include fish, eggs, or milk, or if you have trouble digesting milk (dairy protein allergy). Infants who are only fed breast milk can become deficient in vitamin D because breast milk does not contain enough of this nutrient.

Skin Color

Children of African, Pacific Islander, and Middle Eastern descent are at the highest risk for rickets because their skin is darker and requires more sunlight to react and produce vitamin D.

Geographical Location

You are at a higher risk if you live in an area with little exposure to sunlight, or if you work indoors during daylight hours.

Genes

A form of rickets can be passed down through your genes. This type of rickets, called hereditary rickets, causes your kidneys not to retain phosphate.

What Are the Symptoms of Rickets?

Symptoms of rickets include:

  • pain or tenderness in the bones of your arms, legs, pelvis, or spine
  • deformities in your teeth or delayed tooth formation, an increased number of cavities, holes in your enamel, abscesses, or defects in the structure of your teeth
  • impaired growth and short stature
  • bone fractures
  • muscle cramps
  • skeletal deformities, including:
    • an oddly shaped skull
    • legs that bow out (bowlegs)
    • bumps in your ribcage
    • a protruding breastbone
    • a curved spine
    • pelvic deformities

How Is Rickets Diagnosed?

Your doctor may notice signs of rickets during a physical examination of your child, including signs of tenderness or pain in the child’s bones. Tests to measure blood levels of calcium and phosphate and tests to look at the bones in more depth may help your doctor diagnose rickets.

These tests may include:

  • arterial blood gases
  • blood tests of calcium, phosphorus, parathyroid hormone, and other blood tests
  • bone X-rays

Rarely, a bone biopsy is performed. This involves using a needle to remove a small section of bone for laboratory analysis.

How Is Rickets Treated?

Rickets can be treated by replacing the missing vitamin or mineral in your body. This will eliminate most of your symptoms. If you are deficient in vitamin D, your doctor will likely tell you to (safely) get more sun and eat foods high in vitamin D, such as:

  • fish
  • liver
  • milk
  • eggs

Calcium and vitamin D supplements can also be used to treat rickets. Ask your doctor about the correct dosage, which can vary based on the size of your child. Too much vitamin D or calcium can be unsafe.

If skeletal deformities are present, your child may need braces to position his or her bones correctly as they grow. In severe cases, the child may need corrective surgery.

For hereditary rickets, a combination of phosphate supplements and a special form of vitamin D is required to treat the disease.

Outlook: What Can Be Expected After Treatment?

Replacing vitamin D, calcium, and phosphate will correct the disorder and usually results in improvement in about a week. Skeletal deformities will often improve or disappear over time if the disorder is corrected while the child is still young.

If the disorder is not corrected during a child’s growth period, the skeletal deformities can be permanent and the child may end up with a short stature (less than 5 feet tall) as an adult.

How Can Rickets Be Prevented?

Rickets can be prevented with a diet that includes adequate levels of calcium, phosphorous, and vitamin D, along with moderate sun exposure. According to the National Health Service of England (NHS), you only need to expose your hands and face to sunlight a few times a week during the spring and summer months to prevent rickets (NHS).

Most adults get enough exposure to sunlight. It is important to note that too much sunlight can damage your skin, and sunscreen should be applied to prevent burns and skin damage. However, the use of sunscreen can prevent your skin from producing vitamin D. Eating foods that contain vitamin D or that are fortified with vitamin D or taking vitamin supplements can also prevent the disease.

People with kidney disorders should have their calcium and phosphate levels monitored on a regular basis by their doctors.

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