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Rickets
Classification & external resources

ICD-10	E55.
ICD-9	268
DiseasesDB	9351
MedlinePlus	000344
eMedicine	ped/2014
MeSH	D012279

Rickets is a softening of the bones in children potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries. The predominant cause is a vitamin D deficiency, but lack of adequate calcium in the diet may also lead to rickets. Although it can occur in adults, the majority of cases occur in children suffering from severe malnutrition, usually resulting from famine or starvation during the early stages of childhood. Osteomalacia is the term used to describe a similar condition occurring in adults, generally due to a deficiency of vitamin D.^{[citation needed]}

Contents 1 Epidemiology 2 Etiology 3 Presentation 4 Diagnosis 5 Treatment and prevention 5.1 Diet and sunlight 5.2 Supplementation 6 See also 7 References 8 External links

Those at higher risk for developing rickets include:

• Dark-skinned children
• Breast-fed infants whose mothers are not exposed to sunlight
• Breast-fed infants who are not exposed to sunlight
• Individuals not consuming fortified milk, such as those on vegetarian or vegan diets, or lactose intolerant individuals

Individuals with red hair (who also generally have extremely pale skin that burns rather than tans) have a decreased risk for rickets due to their greater production of vitamin D in sunlight.^[1]

Vitamin D is required for proper calcium absorption from the gut. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in hypocalcemia, leading to skeletal and dental deformities and neuromuscular symptoms, e.g. hyperexcitability.

A rare X-linked dominant form exists called Vitamin D resistant rickets.

Signs and symptoms of rickets include:

• Bone pain or tenderness
• dental problems
• muscle weakness (rickety myopathy or "floppy baby syndrome")
• increased tendency for fractures (easily broken bones), especially greenstick fractures
• Skeletal deformity
  • Toddlers: Bowed legs (genu varus)
  • Older children: Knock-knees (genu valgus) or "windswept knees"
  • Cranial, spinal, and pelvic deformities
• Growth disturbance
• Hypocalcaemia (low level of calcium in the blood), and
• Tetany (uncontrolled muscle spasms all over the body).
• Craniotabes (soft skull)
• Costochondral swelling (aka "rickety rosary" or "rachitic rosary")
• Harrison's groove

An X-ray or radiograph of an advanced sufferer from rickets tends to present in a classic way: bow legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life if not treated.

Long-term consequences include permanent bends or disfiguration of the long bones, and a curved back.

A doctor may diagnose rickets by:

• Blood tests to measure calcium and phosphorus levels
• X-rays of affected bones

Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet in sunshine, cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D.

A sufficient amount of ultraviolet in sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned babies need to be exposed longer to the ultraviolet rays. The replacement of vitamin D has been proven to correct rickets using these methods of ultraviolet light therapyand medicine.

Recommendations are for 200 international units (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance.

Sufficient vitamin D levels can also be achieved through dietary supplementation. Vitamin D3 (cholecalciferol) is the preferred form since it is more readily absorbed than vitamin D2. Most dermatologists recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of skin cancer associated with sun exposure.

According to the American Academy of Pediatrics (AAP), infants who are breast-fed may not get enough vitamin D from breast milk alone. For this reason, the AAP recommends that infants who are exclusively breast-fed receive daily supplements of vitamin D from age 2 months until they start drinking at least 17 ounces of vitamin D-fortified milk or formula a day.

• Osteomalacia

1. ^ Red hair and genetics

• Dr. Susan Ott's website on osteomalacia
• Rickets - Symptoms, Causes, Treatment
• Dictionary.com - Osteomalacia
• Fluoride & Osteomalacia
• History of Vitamin D and the battle against Rickets
• Chorus 00906
• [1]