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.

Symptoms of Rickets

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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Cause of Rickets

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 for Rickets

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.

Difference between Rickets and Osteomalacia

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.

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FAQs on Rickets: Causes, Symptoms, and Prevention

1. What exactly is rickets, and which age group is most affected?

Rickets is a bone condition in children that causes bones to become soft and weak, leading to deformities. It primarily affects infants and children between 6 to 36 months of age, a period of rapid growth when their bones need a lot of calcium and phosphate to develop properly.

2. What are the main causes of rickets?

The most common cause of rickets is a severe and prolonged deficiency of Vitamin D. This vitamin is essential for the body to absorb calcium and phosphate from food. Other causes include:

Lack of calcium or phosphate in the diet.
Insufficient exposure to sunlight, as our skin produces Vitamin D when exposed to the sun.
Genetic conditions that affect how the body processes Vitamin D or phosphate (hereditary rickets).

3. What are the common symptoms of rickets in a child?

The signs and symptoms of rickets can include:

Delayed growth and short stature.
Pain in the spine, pelvis, and legs.
Weak muscles.
Bone deformities such as bowed legs, thickened wrists and ankles, and a projecting breastbone.
Dental problems, like delayed tooth formation and defects in tooth enamel.

4. Why is Vitamin D so important for preventing rickets?

Vitamin D acts like a key that unlocks the body's ability to absorb calcium and phosphate from the intestines. Without enough Vitamin D, the body cannot absorb these essential minerals, no matter how much is consumed. This leads to low levels of calcium and phosphate in the bones, causing them to become soft and misshapen, resulting in rickets.

5. How can rickets be prevented in infants and children?

Prevention focuses on ensuring adequate Vitamin D and calcium intake. This can be achieved through a balanced diet rich in fortified milk, fish, and eggs. For breastfed infants, doctors often recommend Vitamin D drops. Safe, moderate exposure to sunlight also helps the body produce its own Vitamin D naturally.

6. Can adults get rickets, or is it only a childhood disease?

Rickets specifically refers to the condition in children whose bones are still growing. However, adults can suffer from a similar condition called osteomalacia, which also involves the softening of bones due to Vitamin D deficiency. While the cause is the same, the symptoms in adults include dull, aching bone pain, and muscle weakness, rather than the skeletal deformities seen in children.

7. Is it possible to completely cure rickets?

Yes, most cases of rickets caused by nutritional deficiencies can be cured by increasing the intake of Vitamin D and calcium through diet and supplements. Early treatment can often correct many of the skeletal deformities. However, if left untreated for too long, some bone deformities may become permanent.