Malnutrition

Causes of Rickets-Ultimate Guide on Rickets Symptoms & Treatment

Causes of Rickets-Ultimate Guide on Rickets Symptoms & Treatment

Rickets Is A Disease In Children Which May Be Due To The Deficiency Of Vitamin D, Calcium, And Phosphorus. Children With Rickets Have Mainly Soft Bones, Slow Growth And Skeletal Deformities In Serious Cases.

Mainly Developing Countries Suffer From Rickets Like Pakistan. In The Areas Of Middle East Mostly Populations Do Not Have Proper Diet Through Which They Can Not Get Vitamin D, Calcium And Phosphorous Properly And Infants Are Bundled In Clothes So They Have Less Exposure To Sunlight These Are The Main Causes That Leads To Rickets In These Areas.

Percentage Of Vitamin D Deficiency And Its Severity Among Different Groups, Sex And Ages In Pakistan.

Age(Years) Deficiency Less Than 20 Mg/Ml

M                                     F

Insufficient 21 To 30 Mg/Ml

M                                F

Normal More Than 30 Mg/Ml

M                                F

<20

 

67.5 72.1 30.0 24.4 2.5 13.5
21-30 58.8 58.7 28.8 27.7 12.3 13.6
31-40 55.6 52.7 30.3 32.2 14.0 15.0
41-50 51.7 53.4 34.7 29.1 13.6 17.5
51-60 57.5 45.7 25.3 35.3 17.3 19.0
61-70 62.5 44.6 37.5 41.1 0.0 14.3
>70 46.7 58.9 44.4 30.5 8.9 10.5

Rickets Symptoms

Tenderness :

                                Children With Rickets Feel Pain In The Bones Of Arms, Legs, And Pelvis. Children Feel Difficulty In Working And Feel Tired And His/her Walking Will Be Different From Other Children.

Deformities In Skeleton:

                                                  Ankles, Knees, And Wrists Of Children Will Be Come Thick Having Bowed Legs, Skull Shape Will Be Odd Because Of Soft Bones, An Uprising Breast Bones, Spine Will Be In Curved Shape And Deformity In Pelvis Will Occur Also.

Dental Problems:

                                                Children With Rickets Will Have Weak Enamels Of Tooth Formation Of Teeth Will Be Delayed, Suffer From Tooth Cavities, Holes In The Enamels Also And Abscesses.

Retarded Growth:

                                                When The Children Suffer From Rickets He Will Have Poor Growth And Development Of Skeleton And Hence He Will Be Shorter Than Other Children. It Is Because Rickets Often The Bones And Growth Plates At The Bone Ends.

Fragile Bones:

  In Serious Cases Of Rickets Bones Of Children Become Fragile Or Can Be Broken Easily Even It Will Cause Fractures  In Bones.

Role Of Vitamin D In Rickets

Vitamin D Is Sterile Molecule Containing Steroid Nucleus Forms Of Vitamin D

Vitamin And Pro Vitamin.

Forms On Vitamin D On Basis Of Sources.

  • Vitamin D Comes In 3 Forms
  • Vitamin D 1 (Chole Calciferol) Comes From Animal Sources.
  • Vitamin D 2 (Ergosterol) Comes From Plant Issues.
  • Vitamin D 3 (Calcitrol) Found In Animal Tissues.

Biochemical Functions Of Vitamin D

  • Calcitriol Is Active Form Of Vitamin D
  • It Regulates The Plasma Level Of Calcium And Phosphate.
  • Calcitriol Act At Three Different Levels At Bones, Intestine And Kidney To Maintain Plasma Calcium Level.

Action Of Calcitriol On Bones

  • In Osteoblasts Of Bone Calcitriol Stimulate Calcium Uptake For Deposition Of Phosphate.
  • This Calcitriol Is Essential For Bone Formation.
  • The Bone Is An Important Reservoir Of Calcium And Phosphate, Calcitriol Is Along With Parathyroid Harmon Increase The Mobilization Of Calcium And Phosphate From The Bones.
  • This Causes Elevation Of Plasma Calcium And Phosphate Level.

Action Of Calcitriol On Intestine

  • Calcitriol Increases The Intestinal Absorption Of Calcium And Phosphate In The Intestinal Cells Called Mucosal Cells.
  • Calcitriol Binds With The Cytosolic Receptors To Form A Calcitriol Receptor Complex. This Complex Than Approaches The Nucleus And Interact With Specific DNA Leading To Synthesis Of A Specific Calcium Binding Protein.
  • This Protein Increase The Calcium Uptake By The Intestine.
  • The Mechanism Of Action Of Calcitriol On Target Issues Is Similar To The Action Of Steroid Hormones.

Action Of Calcitriol On Kidney

Calcitriol Is Also Involved In Minimizing The Excretion Of Calcium And Phosphate To The Kidney By Their Excretion And enhancing The Reabsorption.

Synthesis Of Active Form Of Vitamin D:

  • Vitamin D2 And D3 Are Not Such Biologically Active Forms.
  • They Are Metabolized Identically In The Body And Converted To Active Forms.

Causes Of Rickets

Exposure To Sunlight

Vitamin D Is Produced In The Skin Whenever Body Is Exposed To The Sunlight. It Is Also Absorbed From Food That We Take In Our Daily Lives. When There Is Little Or No Exposure To Sunlight We Become Deficient Of Vitamin D And Our Body Can Not Absorb Calcium And Phosphorus Properly Due To The Lack Of Vitamin D And Bones Become Soft That Leads To Rickets.

In Other Cases When There Is Low Level Of Vitamin D Our Body Produce Hormones. These Hormones Release The Calcium And Phosphorus From Bones And Our Bones Become Weak And Fragile.

Reasons Of Vitamin D Deficiency Due To Less Exposure To Sunlight

  • Children Of Develop Countries Mostly Use Sun Screen That Trigger The Beneficial Sun Rays To Reach The Skin For Releasing Vitamin D.
  • Some Children Living In The Areas Where There Is Less Exposure To Sunlight or Sun Rays Can Not Reach Properly.
  • Children That Mostly Live Indoor Suffer From Vitamin D Deficiency
  • Another Reason Is That There Are Children With Dark Skin. They Will Absorb Less Amount Of Vitamin D Than That Of Fair Skin.

Lack Of Vitamin D Or Calcium

If There Is Deficiency Of Calcium And Vitamin D In Diet Children Suffer From Rickets It Is because When There Is Deficiency Of Vitamin D Then Calcium Will Not Absorb Properly From Diet That We Eat. It Will Cause Low Calcium In Body Blood. When There Is Low Calcium Level It Will Result Deformities In Bones And Teeth Also Cause Problems Of Nerves And Muscles.

Intestinal, Liver Or Kidney Disorders

Disease Related To Intestine, Liver Or Kidneys Will Interfere With The Absorption Of Vitamin D And Make Difficult To Convert It Into Active Form.

Exclusive Breast Feeding

Mother Who Were Deficient Of Vitamin D, There Infants Will Also Suffer From Vitamin D Deficiency. When There Is Exclusive Breast Feeding Then Infants Will Have Weal And Soft Bones.

Problems With Absorption

Some Diseases Occur That Causes Reduction In The Absorption Such That Absorption Of Fats Vitamin D And Fats Soluble Vitamins.

These Problems May Be

  • Celiac Disease
  • Inflammatory Disease
  • Cystic Fibrosis
  • Kidney Problems

Genetic Causes Of Rickets

  • Hypophosphatemic Rickets
  • It Is Hereditary Problem Which Is Related To Low Phosphate Level In Blood. As We Know That Phosphate Is An Important Mineral For The Formation Of Bones.
  • Most Of The Symptoms In Hypophosphatemic Rickets Starts In Childhood.
  • Risk Factors For Rickets

There Are Following Factors That Are Usually The Main Risk Factors For Rickets:

        Poverty:

                                Main Cause Of Rickets In Under developing Countries Os Poverty. Due To Poverty, The Children Have No Access To The Adequate Nutrition Through Which They Get Vitamin D, Calcium, And Phosphate. Read here: How to Gain Weight Naturally

        Less Or Poor Exposure To Sunlight:

                                                                                Children That Live Indoor Can Not Get Enough Vitamin D From Sunlight But Make Sure That He Is Getting Nutrients From Diet Or Not.

        Malnutrition:

                                                There Are Many Areas In Pakistan Where There Are Starvations And Droughts Due To Shortage Of Food. The Children Of These Areas Mainly Suffer From Rickets Due To Malnutrition. Read here: Signs of Malnutrition

        Diet:

                                In Developing Countries Mainly People Use Only Vegetarian Diet That Do Not Include Fish, Eggs Or Milk And Some People Have Allergy To Milk Sugar Which Is Known As Lactase And Feel Difficulty On Digesting Milk Sugar. These Childrens Also Suffered From Rickets. Children That Are Only Feed On Breast Milk Will Also Suffer From Rickets Because They Can Not Get Enough Vitamin D Only Through Breast Milk. Raed here: Anorexia Nervosa

        Age:

                                Rickets Occur In The Children’s Mostly Who Are In Between 6 And 36 Months. This Is Because It Is The Time When Rapid Growth Occur And Development Start In Children.

        Groups Who Are At Risk Of Developing Rickets:

  • Infants
  • Elders
  • Women Who Remain Covered.
  • Patient Of Kidney Failure
  • Disorders Of Fata Malabsorption
  • Genetic Rickets Which Is Transmitted Inheritably Through Genes
  • Children Having Dark Skin
  • Patients That Used Anti-Convulsant Drugs

Types Of Rickets:

Types Causes Inheritance Pattern Clinical Features Treatment
Nutritional Rickets Or Vitamin D Deficiency Rickets It is due to decreased levels of Vitamin D, Phosphorus Or Calcium Less Exposure To Sunlight, Syndromes Secondary To Malabsorption Like Celiac Disease And Cystic Fibrosis NA Findings In Skeleton, Abnormal Abdomen Shape, Tetany, Seizure, Less Growth, Failure In Thriving. Deficient Nutrients Will Be Replaced Orally, If There Is Malabsorption Vitamin D Is Given Intramuscularly.
Vitamin D Dependent Rickets

Type 1 Or Pseudovitamin D Deficiency Rickets

Type 2 Or Hereditary 1-Α, 25-Dihydroxy Vitamin D Resistant Rickets

 

 

Deficiency Of Renal 25(Oh) D3-1-Α-Hydroxylase

Defects In Interaction Of Calcitriol And Receptor

 

 

Autosomal Recessive

 

Autosomal Recessive

 

Mainly Occur In Children That Are Younger 2 Years, Tetany, Changes In Bone Structure, Seizure

Bone Changes Is Severe, Alopecia

 

 

Calcitriol Is Given

 

 

Calcitriol And Calcium Doses Are Given

Vitamin D Resistant Rickets

Familial Hypophosphatemic Rickets

Heridatory Hypophosphataemic Rickets With Hypercalciuria

 

Impaired Reabsorption Of Phosphate And No Proper Calcitriol Level

Impaired Reabsorption Of Phosphate And Calcitriol Levels Are Increased

 

X Linked Dominant

 

 

Autosomal Recessive And Dominant

 

Short Stature, Bowed Legs, Abnormalities In Teeth

Tenderness And Weakness In Muscle

 

Oral Calcitriol And Phosphate Is Given

 

 

Oral Phosphate Is Given.

Miscellaneous

Renal Osteodystrophy

Prematurity Rickets

Tumor-Induced Rickets

 

Functional Renal Parenchyma Is Lost

Having Multi Factors

Inhibition Of Renal 25(Oh)D3-1-Α Hydroxylase That Is Tumor-Induced

 

NA

 

NA

NA

 

Tenderness, Fractures, Chronic Renal Failure, Decrease Production Of Calcitriol.

Osteopenia, Fractures

Fractures, Bone Pain, Weak Muscles

 

Binding Compounds Of Vitamin D And Phosphate Is Given

Replacing Dietary Deficiencies

Underlying Malignancy Is Treated.

Rickets And Osteomalacia

Osteomalacia Is A Disorder Which Is Characterized By Inadequate Mineralization Of Skeleton That Results In Soft Bones. Now when this occurs in children, it is known as Rickets.

It Occurs When There Is Deficiency Of Vitamin D In Diet Or Person Is Unable To Absorb Vitamin D Properly Which Is Needed For Absorption Of Calcium Also Occur Due To Deficiency Of Calcium And Phosphorus.

Osteomalacia In Adults Can Be Cured Or Treated With In 6 Months But In Rickets It Is Difficult to restore normal function. Sometimes Permanent Deformities Occur.

Rickets Facts

  • May Suffer From Organ Diseases Such As Liver, Kidney, And Skin.
  • Dietary Deficiency Of Vitamin D.
  • Chronic Renal Failure And Haemodialysis Occur In Major Cases.
  • May Occur Due To Side Effects Of Anti-Convulsant Drugs That Are Used During Epilepsy.
  • Hereditary Problems Such That Hypophosphatemia.
  • Symptoms Of Osteomalacia And Rickets.
  • Tenderness In Arms, Legs Spine Majorly In The Hip Bones.
  • Weakness Of Muscles.
  • Bone Deformities And Fractures.
  • Spasms And Cramps Due To Low Level Of Calcium.
  • Bowed Legs- In Rickets Waddling Gait, Pot Shape Belly, Bad Growth.
  • Heart Rhythms Are Abnormal.
  • Arms And Legs Numbness.
  • Numbness Around Mouth.
  • Deformities In Skull Especially In Rickets.
  • Pigeon Chest.
  • Short Stature Due To Poor Growth.
  • Dental Problems.
  • Problems Related To Sleeping.
  • Walking Is Delayed In Children.

Diagnosis Of Rickets And Osteomalacia:

  • Through Patient History.
  • Physical Examination.
  • X-Rays (To Check Levels Of Bone Deformities)
  • Blood Test (To Measure The Levels Of Calcium And Phosphate In Blood)
  • Bone Biopsy (Mostly In Rare Cases, Involve The Removal Of Small Section Of Bone To Diagnose Deformities)

Treatment Of Rickets:

Through Diet:

 Vitamin D Diet:-

                Vitamin D Is Important To Support Strong Bones And Prevent Rickets Ultra Violet Rays Of Sun Hits The Skin For Synthesis Of Vitamin D.  Dark Skin Children Can Not Get Enough Sunlight So They Suffer From Rickets. So, Vitamin D Containing Diet Is Given To The Children To Prevent Rickets.

Vitamin D Diets Are Following:

  • Cod Liver Oil.
  • Fatty Fish.
  • Egg Yolks
  • Beef Liver.

Requirements Of Vitamin D Per Day:

Age Men Women
0 To 1 Year 400 IU 400 IU
1 To 70 Years 600 IU 600 IU
Above 70 Years 800 IU 800 IU

Phosphorus Diet:

  • Eggs
  • Milk
  • Cheese
  • Yogurt
  • Whole Wheat Cereals
  • Salmon
  • Halibut
  • Turkey
  • Chicken
  • Beef

Recommended Daily In Take Of Phosphorus:

  • For Adults 700 Mg
  • Daily Estimated Value 1000 Mg
  • Recently Updated 1250 Mg

Medical Treatment: Rickets Treatment

There Are Following Steps To Treat Rickets Medically:-

Exposure To The Sunlight:

                                                As We Know That Vitamin D Deficiency Is One Of The Root Causes Of Rickets. Sunlight Is Important To Boost Up The Vitamin D Levels. So, Children Having Light Skin Will Have To Take Sun Bath For 3-15 Minutes In A Mid Day.

If Children Have Dark Skin They Should Have Sun Exposure For 15-30 Minutes.

Wear Corrective Braces As Directed By The Doctors:

                                                                                                Sometimes Doctors Directed The Rickets Children To Wear Corrective Braces, Then Make Sure That Your Children Wearing Braces Precisely Or Not Because It Will Helps To Prevent Further Deformities Caused By Rickets.

Gentle Exercise Is Given:

                                                Light And Gentle Exercise Is Given By The Physiotherapist On Regular Basis To Keep Their Joints Moville And It Will Also Helps In Building Muscles Keep Asking The Exercise From Physiotherapist On Regular Basis.

Do No Diagnose On Your Own:

                                                                Children with Rickets Should Not Attempt To Diagnose On Their Own. Patients Should Consult With The Professionals To Determine The Precise Treatment Of Rickets.

Must Know Rickets Risks:

  • Doctor Ask The Rickets Patient To Be Aware Of The Risk Of Rickets Such That
  • They Have Dark Skin.
  • Children Born To A Mother Who Also Suffered From Vitamin D Deficiency During Pregnancy Period.
  • Living In The Areas Where Reaching Of Sunlight Is Less.
  • Rickets Children Being Born Prematurely.
  • Taking Consult About Medication For The Adoption Of Vitamin D Such That Doctors Give Anti-Seizure Medications.

Expect Physical Examination On Regular Intervals:

                                                                                                Doctors Will Evaluate The Pain Or Tenderness In Rickets Children On Regular Physical Examination.

Doctors Ask For Blood Test:

                                                      Doctors Refer Blood Test To Know That Child Has Rickets Or Not. These Tests Are Done To Know About The Calcium And Phosphorus Level In Blood. High Levels Of Alkaline Phosphates Are Also Known By These Tests. Doctors Also Prefer Blood Test To Know The Rickets Is Inhertidly Transmitted Or Not.

Always Prepare For Bone X-Rays:

                                                                Along With Blood Test Doctors Prefer X-Ray Test To Know About The Loss Of Calcium And To See The Changing Shapes Of Their Bones.

Rickets Treatment- Can Rickets Be Cured?

                                Treatment Plans Are Given Before Treating Rickets To The Patient. It Will Help The Patient To Now About The Number Of Supplements. You Should Have Taken On Regular Intervals. Which Type Of Food You Can Eat And Avoid And Also To Know About Correct Use Of Braces.

Consult With Your Doctors On Regular Intervals:

                                                                                                It Is Important To Consult With Your Doctor On Regular Intervals, Keep Regular Checkups, Blood Test And X-Rays And Also Ask About The Reabaluation.

Surgery:

                Sometime Surgery Becomes Important For Rickets Children’s To Correct Their Bone Shapes And Deformities. Surgery Will Depends Upon The Patient History And Also In The Particular Cases It Will Done.

Amount Of Vitamin D Given:

  • Breast Feeding Babies Or Partially Breast Feed, 400 IU Of Vitamin D Per Day.
  • Adolescents Who Do Not Get Foods Having Vitamin D Or Fortified Foods Should Take 400 IU Of Vitamin D Per Day.
  • Pregnant Women Should Get Enough Vitamin D From Diet I.E 600 IU Of Vitamin D Per Day.

About The Author:

                     My Name Is Kanwal Bibi. I Am Doing Bachelors In Human Nutrition And Dietetics. The Purpose Of Being Writing This Article Is To Aware Peoples About Rickets. Today Rickets Is A Common Disease In Pakistan Due To Poverty Levels. So, There Is A Ned To Aware People That How Its Adverse Effects Are On The Lives Of Peoples.

                “Awareness Is Hope For Those With Blount’s Disease”

There Are Motivations Of Many Peoples Behind Writing This Article. I Hope So After Reading This Article People Will Know About Rickets And Its Adverse And Life-Threatening Effects On Their Them.

                                                Thank You.

Goodluck-Team Nutrition Lab

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