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Definition
Rickets (in children) and osteomalacia (in adults) are two forms of a metabolic bone disease resulting from vitamin D deficiency. Both cause softening and weakening of bones because of defective or inadequate bone mineralization.
Rickets
2008 Nucleus Medical Art, Inc.
Causes
Rickets and osteomalacia result when there is a vitamin D deficiency in the body. This may occur when:
- The supply of vitamin D from the diet or sun exposure is inadequate.
- The metabolism of vitamin D is abnormal.
- Tissue is resistant to the action of vitamin D.
Vitamin D regulates calcium absorption in the body. It also controls levels of calcium and phosphate in bone. Vitamin D is absorbed in the intestines from food. Vitamin D is also produced by the skin during exposure to sunlight.
Most often, rickets and osteomalacia are caused by a deficiency of vitamin D. This can result from:
- Insufficient vitamin D in the diet. In children, this may be related to:
- Insufficient consumption of vitamin D-fortified milk
- Insufficient intake of vitamin D supplements to children being breastfed or to children who are lactose intolerant
- Lack of exposure to sunlight.
Less often, rickets and osteomalacia can be caused by other disorders that affect vitamin D absorption, metabolism, or action in the body such as:
Kidney problems: A hereditary disorder of the kidney called vitamin D-resistant ricketsRenal tubular acidosisa nonhereditary kidney disorder which causes bone calcium to dissolve Chronic kidney failure Long-term kidney dialysisDiseases of the small intestines with malabsorptionDisorders of the liver or pancreas diseaseCancer Certain drugs, such as: Certain seizure medications, such as phenytoin or phenobarbitalAcetazolamideAmmonium chlorideDisodium etidronateFluoride treatment Toxicity or poisoning from: CadmiumLeadAluminumOutdated tetracycline Risk Factors A risk factor is something that increases your chance of getting a disease or condition.Risk factors for rickets/osteomalacia include: Age in children: 6 to 24 months old Either the child is consuming breast milk (from a mother who is deficient in vitamin D) or milk not fortified with vitamin D.Age in adults: 50-80 yearsLactose intolerance with inadequate intake of vitamin D-fortified milkFamily history of ricketsRace: Black, especially in association with breastfeeding Symptoms Symptoms may include:
Bone pain and tendernessSkeletal and/or skull deformitiesBow legs or knock kneesDeformity or curvature of the spinePigeon chest (forward protrusion of the chest bone)Impaired growth, resulting in short statureSusceptibility to bone fracturesDental deformitiesDelayed tooth formationDefects in teethIncreased cavitiesLoss of appetite or weight lossDifficulty sleepingPoor muscle development and toneMuscle weaknessDelay of learning to walk in children Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests to confirm the diagnosis may include: Blood and urine tests Bone x-rays Bone biopsy , when other tests are not conclusive Treatment Treatment attempts to: Correct the underlying causeRelieve or reverse symptoms Treating the Underlying Cause Treatment of the underlying cause may include: Adding the following to your diet: Vitamin D-fortified dairy productsFoods high in vitamin D (such as fatty fish, egg yolk, and green vegetables)Supplements of vitamin D, calcium, and other mineralsBiologically active vitamin DAdequate but not excessive exposure to sunlight Treating Symptoms Treatment to relieve or correct symptoms may include:
Wearing braces to reduce or prevent bony deformitiesIn severe cases, surgery to correct bony deformities Prevention To help prevent rickets or osteomalacia: Drink vitamin D-fortified milk.Consume sufficient vitamin D, calcium, and other minerals. If you think your diet may be deficient, talk with your doctor about alternate sources of vitamins and minerals.Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually considered sufficient. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants or children. Children with dark skin and their mothers are at increased risk for rickets and may need more sun exposure and dietary supplementation with vitamin D.Breastfed, dark-skinned babies should receive 400 International Units per day (IU/d) of supplementation with vitamin D starting at no later than two months of age. RESOURCES: American Academy of Pediatricshttp://www.aap.org American Dietetic Associationhttp://www.eatright.org CANADIAN RESOURCES: About Kids Healthhttp://www.aboutkidshealth.ca Alberta Children's Serviceshttp://www.child.alberta.ca/home/ References: Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .
The Merck Manual of Medical InformationHome Edition . Simon and Schuster, Inc; 2000. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/ . Last reviewed December 2007 by Jill Landis, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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