Rickets - Symptoms, Causes, Diagnosis, Treatment

What Are Rickets?

Rickets is a bone disease, and vitamin D is very important for bone formation in children, especially at a growing age. Deficiency or lack of vitamin D leads to improper bone formation where the bones become soft and fragile, these soft bones are easily prone to fractures, and deformities. Rickets is usually seen in children (zero to 24 months).

What Are the Symptoms of Rickets?

• Pain and sensitivity of the joints.

• Poor and delayed development.

• Weakened tooth structure leads to cavities.

• Bones become very fragile and tend to fracture easily.

• Skeletal deformities lead to retarded and stunted growth.

Who Is at Risk of Developing Rickets?

Certain factors increase the chances of getting the disease, these are called risk factors. The risk factors of rickets include:

• Medications: Medications used in the treatment of seizures or AIDS (acquired immunodeficiency syndrome) would interfere with the metabolic process of vitamin D in the body, thus making vitamin D unavailable to the body.

• Breastfeeding Infants: Are at risk of developing rickets, because breast milk does not contain vitamin D.

• Geographical Location: People living in the northern latitudes where there is not enough sunlight, and children are at risk of developing rickets.

• Skin Color: Children with dark skin color take longer to produce vitamin D in the body by using sunlight.

• Lack of Outdoor Activity: This usually occurs in the winter season, when no sufficient sunlight is there to make vitamin D.

• Premature Delivery: Babies born before 36 weeks, do not receive sufficient vitamin D from the mother, leading to deficiency.

What Are the Complications of Rickets?

Rickets is a curable disease, treating it in its early stages would reduce the complications of the disease. Delay in the treatment would result in long-term bone defects such as:

• Spine deformities.

• Retarted or stunted growth.

• Abnormalities in bone formation.

• Improper tooth and jaw development.

• Severe conditions could lead to heart attacks, seizures, and deaths.

How to Diagnose Rickets?

1. Physical Examination: This is a primary diagnostic tool. The doctors apply light pressure on the bones and joints to check the severity of the pain. This includes:

• Skull: Children with rickets have softer skull bones, and fontanels take a long time for complete closure.

• Chest: Deformities in the rib cage can be seen.

• Knees: Bow knees and knock knees are the characteristic feature of rickets. (Bow legs and knock knees are common in infants and children up to six years of age. This should not be misunderstood as rickets).

• Ankles and Wrists: Children usually have twisted ankles and wrists.

1. Imaging Tests: Such as X-rays are advised to check for deformities in the bone.

2. Blood Investigation: Serum calcium, serum phosphorus, and serum alkaline phosphatase are done to check for calcium levels in the blood.

3. Other Tests: Include urine tests, and parathyroid hormone tests which help in calcium detection.

How to Treat Rickets?

Rickets is a curable disease, and can be treated by:

• Calcium and Vitamin D Supplements: Are advised to the patients. Dosage should be advised correctly, as too much is harmful and not safe for the patient.

• Dietary Intake of Calcium and Vitamin D: Foods rich in vitamin D and calcium are advised for patients.

• Adequate Sunlight Exposure: Children are encouraged for outdoor activities, and infants should be placed under early morning sunlight. Houses and schools should have proper ventilation.

• Braces: In order to correct the skeletal deformity braces are advised to correct the posture of the patient.

• Surgery: In severe cases of rickets surgery is required to attain the correct position of bones.

• Hereditary Form of Rickets: Special forms of vitamin D combined with phosphate supplements are advised.

Is There a Prevention for Rickets?

Yes, nutritional rickets (caused due to the deficiency of vitamin D, and calcium) can be prevented by:

• Adequate Exposure to Sunlight: Sunlight is the major source of vitamin D, and it forms under the skin. Children, pregnant women, and infants are advised to have adequate sun exposure for about 15 minutes a day. In some conditions sun exposure makes the skin sensitive and causes inflammation (redness and swelling), this can be prevented by applying sunscreen with a minimum of 30 SPF (sun protective factor). Sunscreen acts as a barrier and prevents the skin from making vitamin D.

• Dietary Recommendations: Proper intake of calcium, vitamin D, and phosphorus decreases the nutritional deficiency of rickets. Patients with improper renal (kidney) function should be checked for calcium and phosphorus in the blood.

• Supplements: Calcium, vitamin D, and phosphorus are recommended to meet the daily requirements of people who don’t have adequate sun exposure.

What Are the Guidelines for Vitamin D Intake?

• Lactating mothers: Are recommended to take 4000 IU (international units) of vitamin D daily, to improve the quantity of vitamin D in their breast milk.

• Pregnant women: Require 1000 to 4000 IU of vitamin D daily. In the first trimester 400 IU, second trimester 1000 IU, and third trimester 4000 IU of vitamin D is required.

• Infants: Are recommended to have 400 IU of vitamin D daily soon after birth.

• Adolescents: Children above the age of four years and adolescents are recommended 400 to 1500 IU of vitamin D daily.

Is There a Relation Between Calcium and Vitamin D?

Vitamin D plays a very important role in bone formation and prevention of rickets. Calcium that is taken in the form of food or supplements reaches the small intestine and gets absorbed there only in the presence of vitamin D. The absorbed calcium and phosphorus reach the bone and help in the formation of hydroxyapatite crystals, and these crystals help in the mineralization of bones. Thus the primary role of vitamin D is to increase the intestinal absorption of calcium.

Hence both calcium and vitamin D should be taken in equal amounts for the correct mineralization of the bone.

Conclusion:

Rickets is a preventable and curable disease, where the bones become soft and fragile. Mainly caused due to deficiency of vitamin D, calcium, and phosphorus. Hence balanced intake of vitamin D and calcium is suggested for proper bone mineralization.