You may have heard about bone disorders while studying biology. You also know that Vitamin D is essential for bones. Rickets is a condition of bone disorder caused by a deficiency of Vitamin D, calcium, or phosphate. It leads to tenderness and weakness in the bones. It is seen commonly in children between 6-24 months of age. There are several types of rickets, such as hypophosphatemic rickets (vitamin-D-resistant rickets), renal or kidney rickets (renal osteodystrophy), and the common nutritional rickets (caused by a dietary deficiency of vitamin D, calcium, or phosphate). Here, we shall study about rickets symptoms, rickets causes, and about its treatment.
The condition of rickets is most common in children who are between 6 and 36 months old. Children are at highest risk of rickets because they are in the growing stages. Some children might not get enough vitamin D if they live in a region with little sunlight, follow a vegetarian diet, or don’t drink enough milk products. In some cases, rickets is hereditary. Rickets was more prevalent earlier, but it disappeared in developed countries during the 1940s. The reason was the introduction of fortified foods, such as cereals with added vitamin D.
1 - Reduced growth and short height
2 - Fractures in bones
3 - Softening of bones
4 - Pain in the bones of arms, legs, pelvis, and spine
5 - Deformities in teeth
6 - Deformities in the skeleton-like bowlegs, and protruding breastbone. Fig.1
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Regardless of the type of rickets, the cause is always a deficiency of vitamin D, calcium, or phosphate. Three characteristics of rickets include nutritional rickets, hypophosphatemic rickets, and renal rickets. The causes of rickets include:
1 - Premature birth (low levels of vitamin D, calcium, and phosphorus);
2 - Limited exposure to the sun (especially in high and low latitudes);
3 - Hereditary metabolic diseases (for example, hypophosphatemic rickets)
4 - Darkly pigmented individuals
5 - Babies born to vitamin D-deficient mothers;
6 – Renal or kidney diseases that affect calcium and phosphorus absorption
7 - Nutrition – Inappropriate calcium and phosphorus intake due to the avoidance of milk products.
Treatment focuses on replacing the missing vitamin in the body. This replacement will eliminate most of the symptoms associated with rickets. If a child has a vitamin D deficiency, then the doctor will advise the parents to increase their exposure to sunlight. They will also be encouraged to consume food products high in vitamin D, such as fish, liver, milk, and eggs.
Calcium and vitamin D supplements are also in use to treat rickets. The doctor can recommend the correct dosage, as it can vary based on the size of the child. Extra intake of vitamin D or calcium can be unsafe.
If skeletal deformities are present, a child may need braces to position their bones correctly as they grow. In severe cases, a child may need corrective surgery.
For hereditary rickets, a combination of phosphate supplements and high levels of a particular form of vitamin D is required to treat the disease.
As mentioned earlier, rickets is of three types:
1 - Hypophosphatemic rickets (vitamin-D-resistant rickets),
2 - Renal or kidney rickets (renal osteodystrophy), and
3 - Common nutritional rickets (caused by a deficiency of vitamin D, calcium, or phosphate).
Common or classic nutritional rickets is medically termed osteomalacia. Nutritional rickets or osteomalacia is a condition caused by vitamin D deficiency. Note that Vitamin D is a fat-soluble vitamin that is essential for the healthy formation of bones and teeth and necessary for the proper absorption of calcium and phosphorus from the stomach. It occurs naturally in minimal quantities through some foods such as saltwater fish such as salmon, sardines, herring, and fish-liver oils. Vitamin D is also typically incorporated by skin cells in response to sunlight exposure. It is necessary for the proper absorption of calcium from the abdomen.
Most at risk for developing nutritional rickets are infants and children with dark-skin, exclusively breastfed infants, and babies who are born to mothers who are vitamin D deficient. Besides, older children who do not get enough exposure to direct sunlight or who have vegan diets may also be at risk.
Q1. Is it Possible to Prevent Rickets?
Ans: Family doctors, pediatricians, and obstetricians are responsible for guiding the parents and would-be parents about adopting the right measures to prevent rickets. For the mother-to-be, it includes recommending prenatal vitamins and appropriate nutrition counseling. For the new mother, she needs to feed her child with fortified food for vitamin D supplementation and reasonable sun exposure. Adults are also advised to get enough exposure to direct sunlight and receive vitamin D supplementation. However, it is advisable to avoid overexposure to sunlight and the overuse of supplements due to health risks. The current dose is at least 400 IU daily.
Q2. What are the Risk Factors for Developing Rickets?
Ans: The risk factors for rickets include any of the following:
Age- rickets is common in children between the ages of 6 to 36 months. Infants experience rapid growth and need most calcium and phosphate.
Diet- there is a risk of rickets if one eats a mostly vegetarian diet that does not have fish, eggs, or milk, and if a person is lactose intolerant.
Geographic locations- our bodies produce more vitamin D when exposed to sunlight. The risk of rickets increases if a person lives in an area that has little sunshine.
Heredity- Genes or family history is also responsible for passing on hereditary rickets.