Rickets is a disorder of bone formation characterized by softening and weakening of the bones in children. It is caused mainly because of Vitamin D deficiency as a result of malnutrition. Vitamin D is essential for Calcium absorption in the intestine and its deficiency leads to insufficiency of Calcium required for proper bone formation.
Vitamin D deficiency with similar symptoms occurring in adulthood is termed as Osteomalacia.
According to a study by M.H. Edwards, Z.A. Cole, N.C. Harvey and C. Cooper “Global Epidemiology Status” published in 2008,” Upto 55% of the infants are suffering from Vitamin D deficiency in Pakistan.”
Rickets is more prevalent in developing countries rather than developed countries and is a major cause of morbidity in infants.
There are two main types of Rickets:
However, we will try to focus on the more come type i.e. the nutritional rickets.
Deficiency of Vitamin D, which required for Calcium absorption from gut, is one of the major causes of Rickets. Following are some of the common reasons:
Lack of healthy intake deficient in vitamin D and Calcium. Foods like fish, milk, eggs, cereals are good sources of vitamin D.
Lack of sun exposure:
Areas where children especially female children are kept at home and covered tend to have higher chances of getting Rickets. This is because lack of exposure to sun light which is a major source of vitamin D. More over cold areas also have a higher prevalence of rickets as compared to hot areas with good amount of sunlight.
Certain diseases interfere with Calcium absorption and Vitamin D synthesis leading to rickets. These include gastrointestinal issues like Celiac Disease, Cystic fibrosis, Liver diseases, Chronic Kidney failure etc.
Symptoms and Diagnosis
Symptoms of Rickets depend on the amount of vitamin deficiency and are more evident with severe deficiency rather than mild. They include weakening of the bones making them unable to carry weight and hence bowing of the legs. Delayed and stunted growth is also seen in children suffering from rickets. Other symptoms include painful bones especially pelvis, spine and legs, painful muscles, thickened wrists and ankles, breast bone projection also known as “Pigeon chest”, frequent fractures etc.
Diagnosis is mostly clinical as x-rays play a very minimal role in diagnosis. It is possible to make definitive diagnosis by getting Serum Calcium and Vitamin D levels checked. To rule out causes other than Malnutrition, it is possible to perform Renal functions test and Liver function test.
Treatment and Prevention
Treatment focuses on providing nutrition. A study published in JAMA in 2013 suggested that infants should be given a daily dose of vitamin D to support bone mineralization. Treatment includes heavy supplementation with Vitamin D and Calcium. Malnutrition associated rickets must include Oral supplementation together with annual parental supplementation and counseling of the parents to increase vitamin D and Calcium rich foods in the diet of their children. Regular exposure to sunlight/ UV light also helps in treatment of rickets.
As it is said that “Prevention is better than cure”, hence parents should keep a healthy source of vitamin and calcium in the routine of their children even if they are not suffering from rickets. Regular milk and eggs intake is surely encouraged. Moreover exposure to sunlight is an essential part of prevention of rickets.