What You Need to Know About Rickets Rickets was once viewed as a public health problem that required urgent care. It was known to have largely fallen off of the public’s radar until recently. Many researchers are calling attention to a revival of rickets. But what is Rickets and why is there a resurge of incidents being seen? Rickets is the softening and weakening of bones in children also known as Osteomalacia in adults, usually because of a vitamin D deficiency or genetic condition. Vitamin D is what promotes the absorption of calcium and phosphorous from the Gestational Intestines tract.
When a person has a vitamin D insufficiency it makes it difficult to maintain proper calcium and phosphorous levels in the bones. There are several different types of Rickets, including Hypophosphatemic Rickets (vitamin D resistant Rickets), Renal Osteodystrophy (renal or kidney Rickets) and most commonly the nutritional Rickets as stated earlier caused by a lack of calcium, phosphate and vitamin D. In this paper we will concentrate more of nutritional Rickets and the causes, risks, treatments and prognosis of these patients.
Vitamin D is a fat-soluble vitamin that is crucial for the normal development of bones and teeth and is vital for the correct absorption of calcium and phosphorus from the bowels. Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones; this will lead to weak and soft bones. Vitamin D can come from several sources such as saltwater fish, milk and other foods.
You may not get enough vitamin D if you are lactose intolerant, which is the inability to digest milk products such as cheese and milk, or you follow a vegetarian diet. Another common cause of Rickets is the absence of sunlight. Vitamin D is naturally produced by skin cells in response to exposure of the sun. This type of vitamin D is critical for the absorption of calcium from the G. I tract. A lack of vitamin D production by the skin may occur in people who live in climates with little or no sunlight, persons who spend the majority of time inside either because of work or who have some other deficiency.
There are many risk factors when it comes to Rickets. First being dark skin. It is said that people of darker skin colors produce less vitamin D then those with lighter complexions. Another risk factor for this disease, are “women who excessively breast feed. Infants who are breastfed may develop a vitamin D deficiency because human breast milk does not supply the proper amount of the vitamin. ” (CITE) This can be a particular problem for darker skinned children in the winter months, when there are lower levels of sunlight. Premature birth is also a common risk factor of Rickets.
Additional hazards include geographical location. Not getting enough calcium and phosphorous in your diet can also lead to Rickets. Rickets caused by the lack of these minerals in your diet is rare in developed countries, because these minerals are found in milk and green vegetables. However, children especially growing up in third world countries don’t have abundant sources of milk or green vegetables. If a person takes anti-seizure medication certain types appear to interfere with the body’s normal ability to use vitamin D. One of the largest risk factors of Rickets is your age.
Kid’s ages 3-36 months old are at most risk because their skeletons are growing so rapidly. It is important at this age that the kids receive the essential minerals the body needs to grow and become strong; not just the vitamins talked in this paper. There are several symptoms associated with Rickets. Some of the more common ones being, impaired growth, bone pain or tenderness in the arms, legs, pelvis and spine, as well as a short stature and skeletal deformities.
Skeletal deformities include an odd shaped skull, bow legs, rachitic rosary or bumps in the ibcage, pigeon chest which is the outward pushing of the breast bone and spine deformities. Spine deformities include spines that curve abnormally such as scoliosis or kyphosis. Scoliosis is when the spine begins to curve from side to side most commonly in an “S” shape. Kyphosis is a convex, curved or rounded, curvature of the spine, with a consequent bulge at the upper back. Other symptoms include dental deformities, including delayed tooth formation, defects in the tooth structure, and holes in the enamel and increased occurrences of cavities.
Many also display an increase in fractures and/or muscle cramps. It is imperative that when any of these symptoms are seen that a person or parent checks with their doctor. Rickets is initially diagnosed clinically with a comprehensive medical and nutritional history and with a complete physical exam by a healthcare professional. The doctor might then run blood and urine tests to check vitamin D, alkaline phosphate, and parathyroid hormone levels. The parathyroid is a hormone that involves the control of calcium and phosphate.
They also might check your electrolytes, which include indirect measurement of kidney function (BUN and Creatinine). A doctor may also order diagnostic imaging or x-rays to demonstration any characteristics that are consistent with Rickets. Some of the imaging that might be ordered are, chest, wrist and ankles, legs and skull x-rays. When a chest x-ray is done they are looking for rachitic rosary which is rib flaring or bumps on the ribcage. Wrist and ankle exams can show a widening or uncharacteristically shaped metaphysis, which is “the most actively growing part of the bone below the growth plate. (CITE) It may also display multiple fractures at different stages of healing. Legs are a very common x-ray to demonstrate the bowing of the legs. Most commonly you see bowing of the legs and spine in radiographs or visually in the person’s physical appearance.
The treatment for Rickets usually depends upon the cause. Braces are common for those that suffer for bowing legs and/or spine. In some cases surgery is required for more severe deformities. In cases of nutritional Rickets the treatment can be quiet modest. The first step is to prevent the complications of calcium and phosphate deficiency by correcting any abnormal levels with supplemental calcium or phosphate as well as the activated vitamin D (calcitriol). ” However it is important to note that an overload of vitamin D can be dangerous. The key to preventing Rickets is to make sure your child is getting enough vitamin D, calcium and adequate sun exposure (with the use of sunscreen). A healthy diet is also important. It is essential the kids are eating vitamin enriched foods daily.
The outcome for children with nutritional Rickets is exceptional, especially if detected early on. Appropriate supplementation with calcium and vitamin D will lead to healing of the bony defects within days to months. Severe bowing, seen in longer-standing cases of Rickets may also resolve over a number of years without requiring surgical intervention. ” (CITE) However, in patients with very progressive stage, the bony changes may be permanent. Treatment of Rickets due to a genetic condition may involve additional medications and treatments to maintain proper bone health and may necessitate a recommendation to an orthopedic professional for evaluation.
