Rickets - wikipedia Rickets Rickets X-ray of a two - year - old with rickets, with a marked bowing of the femurs and decreased bone density Pronunciation / ˈrɪkɪts / Specialty Pediatrics Symptoms Bowed legs, stunted growth, bone pain, large forehead, trouble sleeping Complications Bone fractures, muscle spasms, abnormally curved spine, intellectual disability Usual onset Childhood Causes Diet without enough vitamin D or calcium, dark skin, too little sun exposure, exclusive breastfeeding without supplementation, celiac disease, certain genetic conditions Diagnostic method Blood tests, X-rays Differential diagnosis Fanconi syndrome, scurvy, Lowe syndrome, osteomalacia Prevention Vitamin D supplements for exclusively breastfeed babies Treatment Vitamin D and calcium Frequency Relatively common ( Middle East, Africa, Asia ) Rickets is a condition that results in weak or soft bones in children. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications may include bone fractures, muscle spasms, an abnormally curved spine, or intellectual disability. The most common cause is vitamin D deficiency. This can result from eating a diet without enough vitamin D, dark skin, too little sun exposure, exclusive breastfeeding without vitamin D supplementation, celiac disease, and certain genetic conditions. Other factors may include not enough calcium or phosphorus. The underlying mechanism involves insufficient calcification of the growth plate. Diagnosis is generally based on blood tests finding a low calcium, low phosphorus, and a high alkaline phosphatase together with X-rays. Prevention includes vitamin D supplements for exclusively breastfed babies. Treatment depends on the underlying cause. If due to a lack of vitamin D, treatment is usually with vitamin D and calcium. This generally results in improvements within a few weeks. Bone deformities may also improve over time. Occasionally surgery may be done to fix bone deformities. Genetic forms of the disease typically require specialized treatment. Rickets occurs relatively commonly in the Middle East, Africa, and Asia. It is generally uncommon in the United States and Europe, except among certain minority groups. It begins in childhood, typically between the ages of 3 and 18 months old. Rates of disease are equal in males and females. Cases of what is believed to have been rickets have been described since the 1st century. The disease was common up into the 20th century. Early treatments included the use of cod liver oil. Contents 1 Signs and symptoms 2 Cause 2.1 Sunlight 2.2 Evolutionary considerations 3 Diagnosis 3.1 Types 3.2 Differential diagnosis 4 Treatment and prevention 4.1 Diet and sunlight 4.2 Supplementation 5 Epidemiology 6 History 6.1 Etymology 7 See also 8 References 9 External links Signs and symptoms Widening of wrist Signs and symptoms of rickets can include bone tenderness, and a susceptibility for bone fractures particularly greenstick fractures. Early skeletal deformities can arise in infants such as soft, thinned skull bones -- a condition known as craniotabes which is the first sign of rickets ; skull bossing may be present and a delayed closure of the fontanelles. Young children may have bowed legs and thickened ankles and wrists ; older children may have knock knees. Spinal curvatures of kyphoscoliosis or lumbar lordosis may be present. The pelvic bones may be deformed. A condition known as rachitic rosary can result as the thickening caused by nodules forming on the costochondral joints. This appears as a visible bump in the middle of each rib in a line on each side of the body. This somewhat resembles a rosary, giving rise to its name. The deformity of a pigeon chest may result in the presence of Harrison 's groove. Hypocalcemia, a low level of calcium in the blood can result in tetany -- uncontrolled muscle spasms. Dental problems can also arise. An X-ray or radiograph of an advanced sufferer from rickets tends to present in a classic way : the bowed 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 known as `` caput quadratum ''. These deformities persist into adult life if not treated. Long - term consequences include permanent curvatures or disfiguration of the long bones, and a curved back. Cause Maternal deficiencies may be the cause of overt bone disease from before birth and impairment of bone quality after birth. The primary cause of congenital rickets is vitamin D deficiency in the mother 's blood, which the baby shares. Vitamin D ensures that serum phosphate and calcium levels are sufficient to facilitate the mineralization of bone. Congenital rickets may also be caused by other maternal diseases, including severe osteomalacia, untreated celiac disease, malabsorption, pre-eclampsia, and premature birth. Rickets in children is similar to osteoporosis in the elderly, with brittle bones. Pre-natal care includes checking vitamin levels and ensuring that any deficiencies are supplemented. Also exclusively breast - fed infants may require rickets prevention by vitamin D supplementation or an increased exposure to sunlight. In sunny countries such as Nigeria, South Africa, and Bangladesh, there is sufficient endogenous vitamin D due to exposure to the sun. However, the disease occurs among older toddlers and children in these countries, which in these circumstances is attributed to low dietary calcium intakes due to a mainly cereal - based diet. Those at higher risk for developing rickets include : Breast - fed infants whose mothers are not exposed to sunlight Breast - fed infants who are not exposed to sunlight Breast - fed babies who are exposed to little sunlight Adolescents, in particular when undergoing the pubertal growth spurt Any child whose diet does not contain enough vitamin D or calcium Sunlight Sunlight, especially ultraviolet light, lets human skin cells convert vitamin D from an inactive to active state. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in hypocalcaemia, leading to skeletal and dental deformities and neuromuscular symptoms, e.g. hyperexcitability. Foods that contain vitamin D include butter, eggs, fish liver oils, margarine, fortified milk and juice, portabella and shiitake mushrooms, and oily fishes such as tuna, herring, and salmon. A rare X-linked dominant form exists called vitamin D - resistant rickets or X-linked hypophosphatemia. Cases have been reported in Britain in recent years of rickets in children of many social backgrounds caused by insufficient production in the body of vitamin D because the sun 's ultraviolet light was not reaching the skin due to use of strong sunblock, too much `` covering up '' in sunlight, or not getting out into the sun. Other cases have been reported among the children of some ethnic groups in which mothers avoid exposure to the sun for religious or cultural reasons, leading to a maternal shortage of vitamin D ; and people with darker skins need more sunlight to maintain vitamin D levels. Rickets had historically been a problem in London, especially during the Industrial Revolution. Persistent thick fog and heavy industrial smog permeating the city blocked out significant amounts of sunlight to such an extent that up to 80 percent of children at one time had varying degrees of rickets in one form or the other. It is sometimes known in German as `` the English Disease '' ( Die englische Krankheit ) Diseases causing soft bones in infants, like hypophosphatasia or hypophosphatemia can also lead to rickets. Evolutionary considerations Vitamin D natural selection hypotheses : Rickets is often a result of vitamin D3 deficiency. The vitamin D natural selection hypothesis suggests that vitamin D production from sunlight is a selective force for human skin color variation. The correlation between human skin color and latitude is thought to be the result of positive selection to varying levels of solar ultraviolet radiation. Northern latitudes have selection for lighter skin that allows UV rays to produce vitamin D from 7 - dehydrocholesterol. Conversely, latitudes near the equator have selection for darker skin that can block the majority of UV radiation to protect from toxic levels of vitamin D, as well as skin cancer. An anecdote often cited to support this hypothesis is that Arctic populations whose skin is relatively darker for their latitude, such as the Inuit, have a diet that is historically rich in vitamin D. Since these people acquire vitamin D through their diet, there is not a positive selective force to synthesize vitamin D from sunlight. Environment mismatch : Ultimately, vitamin D deficiency arises from a mismatch between a population 's previous evolutionary environment and the individual 's current environment. This risk of mismatch increases with advances in transportation methods and increases in urban population size at high latitudes. Similar to the environmental mismatch when dark - skinned people live at high latitudes, Rickets can also occur in religious communities that require long garments with hoods and veils. These hoods and veils act as sunlight barriers that prevent individuals from synthesizing vitamin D naturally from the sun. In a study by Mithal et al., Vitamin D insufficiency of various countries was measured by lower 25 - hydroxyvitamin D. 25 ( OH ) D is an indicator of vitamin D insufficiency that can be easily measured. These percentages should be regarded as relative vitamin D levels, and not as predicting evidence for development of rickets. Asian immigrants living in Europe have an increased risk for vitamin D deficiency. Vitamin D insufficiency was found in 40 % of non-Western immigrants in the Netherlands, and in more than 80 % of Turkish and Moroccan immigrants. The Middle East, despite high rates of sun - exposure, has the highest rates of rickets worldwide. This can be explained by limited sun exposure due to cultural practices and lack of vitamin D supplementation for breast - feeding women. Up to 70 % and 80 % of adolescent girls in Iran and Saudi Arabia, respectively, have vitamin D insufficiency. Socioeconomic factors that limit a vitamin D rich diet also plays a role. In the United States, vitamin D insufficiency varies dramatically by ethnicity. Among males aged 70 years and older, the prevalence of low serum 25 ( OH ) D levels was 23 % for non-Hispanic whites, 45 % for Mexican Americans, and 58 % for non-Hispanic blacks. Among women, the prevalence was 28.5 %, 55 %, and 68 %, respectively. A systematic review published in the Cochrane Library looked at children up to three years old in Turkey and China and found there was a negative association between vitamin D and rickets. In Turkey children getting vitamin D had only a 4 % chance of developing rickets compared to children who received no medical intervention. In China, a combination of vitamin D, calcium and nutritional counseling was linked to a decreased risk of rickets. With this evolutionary perspective in mind, parents can supplement their nutritional intake with vitamin D enhanced beverages if they feel their child is at risk for vitamin D deficiency, Diagnosis Wrist X ray showing changes in rickets. Mainly cupping is seen here. Chest X ray showing changes consistent with rickets. These changes are usually referred to as `` rosary beads '' of rickets. Rickets may be diagnosed with the help of : Blood tests : Serum calcium may show low levels of calcium, serum phosphorus may be low, and serum alkaline phosphatase may be high from bones or changes in the shape or structure of the bones. This can show enlarged limbs and joints. A bone density scan may be undertaken. Radiography typically show widening of the zones of provisional calcification of the metaphyses secondary to unmineralized osteoid. Cupping, fraying, and splaying of metaphyses typically appears with growth and continued weight bearing. These changes are seen predominantly at sites of rapid growth, including the proximal humerus, distal radius, distal femur and both the proximal and the distal tibia. Therefore, a skeletal survey for rickets can be accomplished with anteroposterior radiographs of the knees, wrists, and ankles. Types Vitamin D - related rickets Vitamin D deficiency Vitamin D - dependent rickets Type 1 ( 25 - Hydroxyvitamin D3 1 - alpha - hydroxylase deficiency ) Type 2 ( calcitriol receptor mutation ) Hypocalcemia - related rickets Hypocalcemia Chronic renal failure ( CKD - BMD ) Hypophosphatemia - related rickets Congenital Vitamin D - resistant rickets Autosomal dominant hypophosphatemic rickets ( ADHR ) Autosomal recessive hypophosphatemic rickets ( ARHR ) Hypophosphatemia ( typically secondary to malabsorption ) Fanconi 's syndrome Secondary to other diseases Tumor - induced osteomalacia McCune - Albright syndrome Epidermal nevus syndrome Dent 's disease Differential diagnosis Infants with rickets often have bone fractures. This sometimes leads to child abuse allegations. This issue appears to be more common for solely nursing infants of black mothers, in winter in temperate climates, suffering poor nutrition and no vitamin D supplementation. People with darker skin produce less vitamin D than those with lighter skin, for the same amount of sunlight. Treatment and prevention The most common treatment of rickets is the use of vitamin D. However, surgery may be required to remove severe bone abnormalities. Diet and sunlight Cholecalciferol ( D ) Ergocalciferol ( D ) Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet B light ( most easily obtained when the sun is highest in the sky ), cod liver oil, halibut - liver oil, and viosterol are all sources of vitamin D. A sufficient amount of ultraviolet B light in sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker - skinned people 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 therapy and medicine. Recommendations are for 400 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. Supplementation Sufficient vitamin D levels can also be achieved through dietary supplementation and / or exposure to sunlight. Vitamin D ( cholecalciferol ) is the preferred form since it is more readily absorbed than vitamin D. 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. Endogenous production with full body exposure to sunlight is approximately 250 μg ( 10,000 IU ) per day. According to the American Academy of Pediatrics ( AAP ), all infants, including those who are exclusively breast - fed, may need vitamin D supplementation until they start drinking at least 17 US fluid ounces ( 500 ml ) of vitamin D - fortified milk or formula a day. Epidemiology. In developed countries, rickets is a rare disease ( incidence of less than 1 in 200,000 ). Recently, cases of rickets have been reported among children who are fed plant - based milk substitutes and not given supplemental vitamin D. In 2013 / 2014 there were fewer than 700 cases in England. History Skeleton of Infant with Rickets, 1881 Greek physician Soranus of Ephesus, one of the chief representatives of the Methodic school of medicine who practiced in Alexandria and subsequently in Rome, reported deformation of the bones in infants as early as the first and second centuries AD. Rickets was not defined as a specific medical condition until 1645, when an English physician Daniel Whistler gave the earliest known description of the disease. In 1650 a treatise on rickets was published by Francis Glisson, a physician at Caius College, Cambridge, who said it had first appeared about 30 years previously in the counties of Dorset and Somerset. In 1857, John Snow suggested rickets, then widespread in Britain, was being caused by the adulteration of bakers ' bread with alum. German pediatrician Kurt Huldschinsky successfully demonstrated in the winter of 1918 -- 1919 how rickets could be treated with ultraviolet lamps. The role of diet in the development of rickets was determined by Edward Mellanby between 1918 -- 1920. In 1923, American physician Harry Steenbock demonstrated that irradiation by ultraviolet light increased the vitamin D content of foods and other organic materials. Steenbock 's irradiation technique was used for foodstuffs, but most memorably for milk. By 1945, rickets had all but been eliminated in the United States ; no cases have been recorded in Cuba, but they are there since the Special Period. Etymology The word rickets may be from the Old English word wrickken ( ' to twist ' ), although because this is conjectured, several major dictionaries simply say `` origin unknown ''. The name rickets is plural in form but usually singular in construction. The Greek word `` rachitis '' ( ῥαχίτης, meaning `` in or of the spine '' ) was later adopted as the scientific term for rickets, due chiefly to the words ' similarity in sound. See also Hypervitaminosis D References ^ Jump up to : `` Rickets ''. Genetic and Rare Diseases Information Center ( GARD ) -- an NCATS Program. 2013. Retrieved 19 December 2017. ^ Jump up to : `` Rickets, Vitamin D Deficiency ''. NORD ( National Organization for Rare Disorders ). 2005. Retrieved 19 December 2017. ^ Jump up to : Creo, AL ; Thacher, TD ; Pettifor, JM ; Strand, MA ; Fischer, PR ( May 2017 ). `` Nutritional rickets around the world : an update ''. Paediatrics and international child health. 37 ( 2 ) : 84 -- 98. doi : 10.1080 / 20469047.2016. 1248170. PMID 27922335. ^ Jump up to : `` Rickets - OrthoInfo - AAOS ''. September 2010. Retrieved 19 December 2017. Jump up ^ Florin, Todd ; MD, Stephen Ludwig ; Aronson, Paul L. ; Werner, Heidi C. ( 2011 ). Netter 's Pediatrics E-Book. Elsevier Health Sciences. p. 430. ISBN 1455710644. ^ Jump up to : Rajakumar, K ( August 2003 ). `` Vitamin D, cod - liver oil, sunlight, and rickets : a historical perspective ''. Pediatrics. 112 ( 2 ) : e132 -- 5. doi : 10.1542 / peds. 112.2. e132. PMID 12897318. ^ Jump up to : Medical News -- Symptoms of Rickets Jump up ^ Harvey, Nicholas C. ; Holroyd, Christopher ; Ntani, Georgia ; Javaid, Kassim ; Cooper, Philip ; Moon, Rebecca ; Cole, Zoe ; Tinati, Tannaze ; Godfrey, Keith ; Dennison, Elaine ; Bishop, Nicholas J. ; Baird, Janis ; Cooper, Cyrus ( 2014 ). `` Vitamin D supplementation in pregnancy : a systematic review ''. Health Technology Assessment ( Winchester, England ). 18 ( 45 ) : 1 -- 190. doi : 10.3310 / hta18450. ISSN 2046 - 4924. Jump up ^ Prentice, Ann ( July 2013 ). `` Nutritional rickets around the world ''. The Journal of Steroid Biochemistry and Molecular Biology. 136 : 201 -- 206. doi : 10.1016 / j. jsbmb. 2012.11. 018. PMID 23220549. Jump up ^ Mayo Clinic -- Signs and Symptoms of Rickets Jump up ^ `` caput quadratum ''. TheFreeDictionary.com. Jump up ^ Pharmacologyonline. `` Rickets and its Management : A Review '' ( PDF ). Retrieved 2 June 2012. ^ Jump up to : Elidrissy AT ( 2016 ). `` The Return of Congenital Rickets, Are We Missing Occult Cases ? ''. Calcif Tissue Int ( Review ). 99 ( 3 ) : 227 -- 36. doi : 10.1007 / s00223 - 016 - 0146 - 2. PMID 27245342. ^ Jump up to : Paterson CR, Ayoub D ( 2015 ). `` Congenital rickets due to vitamin D deficiency in the mothers ''. Clin Nutr ( Review ). 34 ( 5 ) : 793 -- 8. doi : 10.1016 / j. clnu. 2014.12. 006. PMID 25552383. Jump up ^ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Jump up ^ http://www.webmd.com/baby/guide/prenatal-vitamins#1 Jump up ^ Balasubramanian S, Ganesh R ( 2008 ). `` Vitamin D deficiency in exclusively breast - fed infants ''. The Indian Journal of Medical Research ( Review ). 127 ( 3 ) : 250 -- 5. PMID 18497439. Jump up ^ Pettifor JM ( 2004 ). `` Nutritional rickets : deficiency of vitamin D, calcium, or both ? ''. The American Journal of Clinical Nutrition ( Review ). 80 ( 6 Suppl ) : 1725S -- 9S. PMID 15585795. Jump up ^ Glorieux FH, Pettifor JM ( 2014 ). `` Vitamin D / dietary calcium deficiency rickets and pseudo-vitamin D deficiency rickets ''. BoneKEy Reports ( Review ). 3 : 524. doi : 10.1038 / bonekey. 2014.19. PMC 4015456. PMID 24818008. Jump up ^ Daily Telegraph, page 4, Wednesday 19 January 2011 Jump up ^ Rise in rickets linked to ethnic groups that shun the sun The Independent, published 2011 - 07 - 25, accessed 2011 - 07 - 251 Jump up ^ Doctors fear rickets resurgence BBC, published 2007 - 12 - 28, accessed 2011 - 07 - 25 Jump up ^ `` Hypophosphatasia : Signs and Symptoms ''. Hypophosphatasia.com. Retrieved 10 September 2014. Jump up ^ Yuen, A.W.C. ; Jablonski, N.G. ( January 2010 ). `` Vitamin D: In the evolution of human skin colour ''. Medical Hypotheses. 74 ( 1 ) : 39 -- 44. doi : 10.1016 / j. mehy. 2009.08. 007. PMID 19717244. Jump up ^ Murray, F.G. ( July -- September 1934 ). `` Pigmentation, Sunlight, and Nutritional Disease ''. American Anthropologist. 36 ( 3 ) : 438 -- 445. doi : 10.1525 / aa. 1934.36. 3.02 a00100. Jump up ^ Loomis, W.G. ( August 1967 ). `` Skin - pigment regulation of vitamin - D biosynthesis in man ''. Science. 157 ( 3788 ) : 501 -- 6. doi : 10.1126 / science. 157.3788. 501. PMID 6028915. Jump up ^ Barr, Sharma ; Macdonald H.M., Sheehy T., Novotny R., Corriveau A. ( August 2011 ). `` Vitamin D deficiency and disease risk among aboriginal Arctic populations ''. Nutritional Review. 69 ( 8 ) : 468 -- 478. doi : 10.1111 / j. 1753 - 4887.2011. 00406. x. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Bachrach, S. ; Fisher J., Parks J.S. ( 1979 ). `` An outbreak of vitamin D deficiency rickets in a susceptible population ''. Pediatrics Volume. 64 ( 6 ) : 871 -- 877. Jump up ^ Mithal, A. ; Wahl D.A., Bonjour J.P., Burckhardt T., Dawson - Hughes B., Eisman J.A., El - Hajj Fuleihan G., Josse R.G., Lips P., Morales - Torres J. ( 19 June 2009 ). `` Global vitamin D status and determinants of hypovitaminosis D '' ( PDF ). Osteoporosis International. 20 : 1807 -- 1820. doi : 10.1007 / s00198 - 009 - 0954 - 6. CS1 maint : Multiple names : authors list ( link ) Jump up ^ THE MIDDLE EAST & AFRICA REGIONAL AUDIT, Executive Summary, Epidemiology, costs & burden of osteoporosis in 2011, The International Osteoporosis Foundation, www.iofbonehealth.org, retrieved 6 April 2017 Jump up ^ Lerch, C ; Meissner, T ( 17 October 2007 ). `` Interventions for the prevention of nutritional rickets in term born children ''. The Cochrane Database of Systematic Reviews ( 4 ) : CD006164. doi : 10.1002 / 14651858. CD006164. pub2. PMID 17943890. Jump up ^ Weisberg, P. ; Scanlon K.S., Ruowei L., Cogswell M.E. ( 2004 ). `` Nutritional rickets among children in the United States : review of cases reported between 1986 and 2003 ''. The American Journal of Clinical Nutrition. 80 ( 6 ) : 1697S -- 1705S. CS1 maint : Multiple names : authors list ( link ) ^ Jump up to : NHS Choice - Rickets Diagnoses ^ Jump up to : Cheema, Jugesh I. ; Grissom, Leslie E. ; Harcke, H. Theodore ( 2003 ). `` Radiographic Characteristics of Lower - Extremity Bowing in Children ''. RadioGraphics. 23 ( 4 ) : 871 -- 880. doi : 10.1148 / rg. 234025149. ISSN 0271 - 5333. ^ Jump up to : Rickets : Not a Disease of the Past Jump up ^ Levy - Litan V, Hershkovitz E, Avizov L, Leventhal N, Bercovich D, Chalifa - Caspi V, Manor E, Buriakovsky S, Hadad Y, Goding J, Parvari R. `` Autosomal - recessive hypophosphatemic rickets is associated with an inactivation mutation in the ENPP1 gene ''. Am J Hum Genet. 86 : 273 -- 8. doi : 10.1016 / j. ajhg. 2010.01. 010. PMC 2820183. PMID 20137772. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Keller, Kathy A. ; Barnes, Patrick D. ( 22 September 2008 ). `` Rickets vs. abuse : a national and international epidemic '' ( PDF ). Pediatric Radiology. 38 ( 11 ) : 1210 -- 1216. doi : 10.1007 / s00247 - 008 - 1001 - z. PMID 18810424. Jump up ^ Live Strong. `` CDark Skin Color & Vitamin D ''. Retrieved 2 June 2012. Jump up ^ Meschino Health. `` Complete Guide to Vitamin D ''. Retrieved 2 June 2012. Jump up ^ Rajakumar, Kumaravel ( 1 August 2003 ). `` Vitamin D, Cod - Liver Oil, Sunlight, and Rickets : A Historical Perspective ''. Pediatrics. 112 ( 2 ) : e132 -- e135. doi : 10.1542 / peds. 112.2. e132. PMID 12897318. Retrieved 14 July 2011. Jump up ^ Vieth R ( May 1999 ). `` Vitamin D supplementation, 25 - hydroxyvitamin D concentrations, and safety ''. The American Journal of Clinical Nutrition. 69 ( 5 ) : 842 -- 56. PMID 10232622. Jump up ^ Gartner LM, Greer FR ( April 2003 ). `` Prevention of rickets and vitamin D deficiency : new guidelines for vitamin D intake ''. Pediatrics. 111 ( 4 Pt 1 ) : 908 -- 10. doi : 10.1542 / peds. 111.4. 908. PMID 12671133. Jump up ^ National Health Service of England > Rickets Last reviewed : 28 January 2010 Jump up ^ http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2014/20141020_hn Jump up ^ `` Rickets and osteomalacia ''. nhs.uk. Retrieved 24 December 2017. Jump up ^ Claerr, Jennifer ( February 6, 2008 ). `` The History of Rickets, Scurvy and Other Nutritional Deficiencies ''. An Interesting Treatise on Human Stupidity. Yahoo ! Voices. Archived from the original on 2013 - 03 - 26. URL references Jump up ^ Gibbs D ( 1994 ). `` Rickets and the crippled child : an historical perspective ''. Journal of the Royal Society of Medicine. 87 ( 12 ) : 729 -- 32. PMC 1294978. PMID 7503834. Jump up ^ Dunnigan M ( 2003 ). `` Commentary : John Snow and alum - induced rickets from adulterated London bread : an overlooked contribution to metabolic bone disease ''. International Journal of Epidemiology. 32 ( 3 ) : 340 -- 1. doi : 10.1093 / ije / dyg160. PMID 12777415. Jump up ^ Pileggi VJ, De Luca HF, Steenbock H ( September 1955 ). `` The role of vitamin D and intestinal phytase in the prevention of rickets in rats on cereal diets ''. Archives of Biochemistry and Biophysics. 58 ( 1 ) : 194 -- 204. doi : 10.1016 / 0003 - 9861 ( 55 ) 90106 - 5. PMID 13259690. Jump up ^ Ford JA, Colhoun EM, McIntosh WB, Dunnigan MG ( 1972 ). `` Biochemical Response of Late Rickets and Osteomalacia to a Chupatty - free Diet ''. British Medical Journal. 3 ( 5824 ) : 446 -- 7. doi : 10.1136 / bmj. 3.5824. 446. PMC 1786011. PMID 5069221. Jump up ^ Rajakumar K ( 2003 ). `` Vitamin D, cod - liver oil, sunlight, and rickets : a historical perspective '' ( PDF ). Pediatrics. 112 ( 2 ) : e132 -- 5. doi : 10.1542 / peds. 112.2. e132. PMID 12897318. Jump up ^ Greek Word Study Tool External links Classification ICD - 10 : E55 ICD - 9 - CM : 268 DiseasesDB : 9351 External resources MedlinePlus : 000344 eMedicine : ped / 2014 Patient UK : Rickets hide Malnutrition or nutrition disorders ( E40 -- E68, 260 -- 269 ) Malnutrition Protein - energy malnutrition Kwashiorkor Marasmus Catabolysis Vitamin deficiency B vitamins B : Beriberi / Wernicke -- Korsakoff syndrome ( Wernicke 's encephalopathy Korsakoff 's syndrome ) B : Riboflavin deficiency B : Pellagra ( Niacin deficiency ) B : Pyridoxine deficiency B : Biotin deficiency B : Folate deficiency B : Vitamin B deficiency Other vitamins A : Vitamin A deficiency / Bitot 's spots C : Scurvy D: Vitamin D deficiency / Rickets / Osteomalacia E : Vitamin E deficiency K : Vitamin K deficiency Mineral deficiency Sodium Potassium Magnesium Calcium Iron Zinc Manganese Copper Iodine Chromium Molybdenum Selenium ( Keshan disease ) Overnutrition Overweight Obesity Childhood obesity Obesity hypoventilation syndrome Abdominal obesity Vitamin poisoning Hypervitaminosis A Hypervitaminosis D Hypervitaminosis E Mineral overload see inborn errors of metal metabolism, toxicity NDL : 00567048 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Rickets&oldid=845179467 '' Categories : Skeletal disorders Vitamin D Vitamin deficiencies Hidden categories : CS1 maint : Multiple names : authors list Use dmy dates from May 2014 Infobox medical condition ( new ) All articles with unsourced statements Articles with unsourced statements from February 2017 All articles lacking reliable references Articles lacking reliable references from November 2017 Wikipedia articles with NDL identifiers RTT Talk Contents About Wikipedia Asturianu Български Bosanski Català Čeština Cymraeg Dansk Deutsch Ελληνικά Español Esperanto Euskara فارسی Français Gaeilge 한국어 Հայերեն हिन्दी Hrvatski Ido Bahasa Indonesia Italiano עברית ಕನ್ನಡ ქართული Қазақша Kiswahili Кыргызча Lietuvių Magyar Македонски Nederlands 日本 語 Norsk ଓଡ଼ିଆ Polski Português Русский Sicilianu Simple English Slovenčina Slovenščina Српски / srpski Suomi Svenska Tagalog தமிழ் ไทย Türkçe Українська Tiếng Việt 中文 44 more Edit links This page was last edited on 10 June 2018, at 00 : 11 ( UTC ). 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Question: the name of a condition caused by an abnormally low level of calcium in the blood is
Answer: Rickets