There are many diseases which affect human being due to deficiency of nutrients required by the body. Among those different diseases, rickets is one which affects an individual due to a deficiency of vitamin D, calcium, or phosphate. All these nutrients are necessary to make our bones strong and healthy.
What is Rickets?
The term Rickets is derived from the Old English word “wrickken”, meaning to twist or bend. In the 19th century, the disease became an epidemic in the UK and US. Now, the condition has more impact on developing countries. Hence, this disease is the most common childhood disease in many developing countries.
Rickets is a bone disorder, softening, and weakening of bones in children. The disease is caused by extreme and prolonged vitamin D deficiency and becomes prone to fractures and deformity, a condition linked to malnutrition. It also causes skeletal deformities and stunted growth. Also, not consuming enough calcium and phosphate can cause rickets. However, not enough Vitamin D makes it difficult for the body to maintain proper calcium and phosphorous level in bones which cause rickets. Therefore, the leading cause of rickets is lack of vitamin D. The disease mostly affects children, but in rare cases, adults can also suffer from rickets.
Adding Vitamin D or calcium to the diet generally corrects rickets. But when rickets is due to another underlying medical problem, the patient needs to seek medical attention. Some skeletal deformities caused by rickets requires corrective surgery.
Types of Rickets
Nutritional Rickets results from insufficient exposure to the sunlight or dietary deficiency of Vitamin D, calcium, and phosphorus. Vitamin D deficiency can occur when the infant is dark skinned. Dark skin person requires more exposure to sunlight than others to produce the same amount of Vitamin D.
Source of Vitamin D: Sunlight, milk, mushroom, egg yolk, fatty fish like tuna, salmon and mackerel, cheese, etc.
Calcium: Almond, sesame, orange, dairy products, soybean, tofu, etc.
Phosphorus: milk and milk products, high protein foods like meat, beans, lentils, nuts, whole grain, sunflower and pumpkin seeds, etc.
This particular form of rickets is caused due to a low level of phosphate in the bone, which causes the bone to become painfully soft and pliable. Hypophosphatemic rickets is not caused by the deficiency of Vitamin D instead, it is caused due to mutations of the phosphate-regulating gene on the X chromosome. This defect in the ability of kidneys to control the amount of phosphate excreted in the urine causes Hypophosphatemic Rickets. i.e., isolated deficiency in renal reabsorption of phosphorus.
Various medical condition and medication can cause rickets like Disease of organs associated with Vitamin D and calcium metabolism, kidney disease, liver, and biliary tract disease, celiac disease, and so on.
There are several signs and symptoms related to Rickets. As it makes the bones weaker and obstructs the normal development, the disorder mostly affects the bones. Some of the significant symptoms or Rickets includes:
- The bones become soft and tender which causes an increased tendency for fractures,
- The muscles also may become weak,
- Short height and low weight,
- Floppiness in the limbs of an infant,
- It creates a disturbance in a healthy growth process of the children, delayed growth,
- There will be a low level of calcium in the blood called Hypocalcemia,
- The skull may become softer,
- Uncontrolled muscle spasms all over the body, also known as Tetany,
- Due to metaphyseal cartilage hyperplasia, the wrists may widen,
- Toddlers may have bowed legs known as genu varum,
- Older children may have knock knees (Genu Valgum),
- Presence of a horizontal line at the lower margin of the thorax,
- It can cause a deformity in the spine, pelvis, ribcage or the chest,
- Rickets can also cause dental problems.
You need to see a doctor if your child develops bone pain, muscle weakness, or skeletal deformities.
What is the main cause of Rickets?
The leading cause of Rickets is the deficiency of Vitamin D. Vitamin D absorbs the required calcium from the intestines. If our body doesn’t get enough vitamin D, then our body cannot absorb calcium and phosphorus from the food we eat. As a result, the person suffers from hypocalcemia, which makes the bones, muscles, and teeth weaker. It prevents our skin cells from converting vitamin D from an inactive into an active state.
Lack of Vitamin D
The body needs Vitamin D to absorb calcium from the intestines. The Ultraviolet light (UV light) in the sunlight helps skin cell to convert Vitamin D from an inactive state to an active state. If a person does not have enough Vitamin D, then calcium is not absorbed properly from the food we eat, causing a lower level of calcium in the blood.
Adding Vitamin D to the diet is relatively simple. Foods like, fish oil, eggs, milk, and milk products, soybean, soy milk, tofu is rich with Vitamin D. You can easily improve Vitamin D deficiency with a small change in the diet of your child which makes to cause of rickets avoidable.
A genetic disorder is another cause of rickets in which the kidneys cannot process phosphate properly. Because of this, the phosphate in blood levels become too low, leading to weak and soft bones. In case of some diseases like kidney, liver, and intestinal problems, there might be problems in the way the body absorbs and metabolizes minerals and vitamins, resulting in rickets. There are also cases in which severe diarrhea and vomiting have caused Rickets.
Also Read: Hypercalcemia: Causes, Symptoms, Treatment
Who is at Risk?
There are higher chances of getting rickets among children from the low-income family background. Most children who don’t get enough sunlight, a balanced diet, and are living in drought-hit countries are at high risk of rickets. Rickets is most common in children between 6 to 36 months old. It is also noted that most people who eat a vegetarian diet or have a problem in digesting milk are at high risk of rickets. In the countries which fall in a geographical region without enough sunlight, the children and people are at more risk.
The people who mostly work indoors may also have high chances of getting Rickets than other people. According to studies, children of African descent who have dark skin are prone to Rickets because dark skin cannot react strongly to sunlight as light skin does.
In the case of hereditary rickets, the disorder passes through the genes because of which the kidneys cannot absorb phosphate, which can result in Rickets. In recent times studies have also proven that in developed countries, the maximum use of sun block creams has resisted the body to absorb the necessary amount of sunlight which causes a deficiency of vitamin D and puts the children at risk.
Rickets is curable if it is properly diagnosed on time. Diagnosis includes examination by a physician doctor where he/she examines the tenderness or pain in the bones by lightly pressing on the bones.
The doctor may recommend certain tests, including blood tests, to measure the levels of calcium and phosphate in the blood.
Bone X-rays to check for bone deformities consistent with rickets:
- Obvious bowing of the femurs,
- Rib flaring
- Multiple fractures at different healing stage
- Abnormally shaped metaphysis.
Arterial blood gases check the quantity of calcium and phosphate in the blood. In some rare cases, the doctor may suggest for bone biopsy in which a tiny section of bone is removed and sent to the laboratory for analysis.
- Treatment includes replacing the missing vitamin or mineral in the body. If a child is suffering from Vitamin D deficiency, then the doctor will suggest the parents expose the child to more sunlight.
- It is necessary to increase the intake of food, which is high in nutrients containing vitamin D, such as fish, liver, milk, and eggs.
- Vitamin D or calcium capsules are also available in the market which can replace the deficiency of those nutrients in the body. But you need to take them only under expert doctors’ advice.
- Overconsumption of Vitamin D and Calcium capsules without doctor’s advice can be dangerous. Braces can correct the skeletal deformities if any. The treatment also requires a combination of phosphate supplements and high levels of a certain form of vitamin D, if it is of hereditary type.
- If the treatment is done in time, then the symptoms will begin to disappear within a week of taking the nutrient-rich food or medicines. There can be permanent skeletal deformities if you don’t treat the child in time.
Preventive Measures For Rickets
As the famous saying goes by ‘Prevention is better than cure’ so it is better to adopt a healthy lifestyle and eat healthy food containing enough nutrients such as butter, margarine, fish, liver, juice, milk, and eggs which will help to prevent Rickets.
It is essential to eat a diet that includes adequate amounts of calcium, phosphorous, and vitamin D. Enough sunlight exposure is necessary so that the body absorbs necessary ultraviolet rays. The children should be encouraged out go out and play in the sun a few times in a week. But we should also be careful of overexposure in the sun which can cause damage too. Those who have kidney problem should check their calcium and phosphate levels regularly and seek consultation from doctors.
If you are pregnant, ask your doctor to prescribe you Vitamin D supplements. A guideline recommends that all infant should receive 400 IU a day of vitamin D because human milk contains a small amount of Vitamin D. Bottle fed infants may also need Vitamin D supplements if they aren’t receiving enough from their formula.