Rickets, Vitamin D Deficiency Rickets, Vitamin D Deficiency Important It is possible that the main title of the report Rickets, Vitamin D Deficiency is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Synonyms None General Discussion Vitamin-D deficiency rickets, a disorder that becomes apparent during infancy or childhood, is the result of insufficient amounts of vitamin D in the body. The vitamin deficiency may be caused by poor nutrition , a lack of exposure to the sun, or malabsorption syndromes in which the intestines do not adequately absorb nutrients from foods. Vitamin D is needed for the metabolism of calcium and phosphorus in the body, which, in turn affects how calcium is deposited in the bones; thus it is considered essential for proper bone development and growth. Major symptoms of vitamin D deficiency rickets include bone disease, restlessness, and slow growth. This disorder is rare in the United States but is not uncommon in certain areas of the world.

Resources NIH/National Institute of Diabetes , Digestive & Kidney Diseases Office of Communications & Public Liaison Bldg 31, Rm 9A06 31 Center Drive, MSC 2560 Bethesda, MD 20892-2560 Internet: For a Complete Report This is an abstract of a report from the National Organization for Rare Disorders (NORD). A copy of the complete report can be downloaded free from the NORD website for registered users. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational therapies (if available), and references from medical literature. For a full-text version of this topic, go to and click on Rare Disease Database under "Rare Disease Information". The information provided in this report is not intended for diagnostic purposes. It is provided for informational purposes only. NORD recommends that affected individuals seek the advice or counsel of their own personal physicians. It is possible that the title of this topic is not the name you selected. Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report This disease entry is based upon medical information available through the date at the end of the topic.

Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. For additional information and assistance about rare disorders, please contact the National Organization for Rare Disorders at P.O. Box 1968, Danbury, CT 06813-1968; phone (203) 744-0100; web site or email orphan@rarediseases.org Last Updated: 4/25/2008 Rickets Causes, Symptoms,Treatments & Prevention Medical Author: David Perlstein, MD, MBA, FAAP David Perlstein, MD, MBA, FAAP Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx. Medical Editor: William C. Shiel Jr., MD, FACP, FACR William C.

Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Share Your Story Rickets is a bone disorder caused by a deficiency of vitamin D, calcium, or phosphate. Rickets leads to softening and weakening of the bones and is seen most commonly in children 6-24 months of age. There are several subtypes of rickets, including hypophosphatemic rickets (vitamin-D-resistant rickets), renal or kidney rickets ( renal osteodystrophy ), and most commonly, nutritional rickets (caused by dietary deficiency of vitamin D, calcium, or phosphate). Classic nutritional rickets is also medically termed osteomalacia. What is the history of rickets?

Roman descriptions of individuals with rickets can be found as early as the second century, and in the 1640s, the condition was well documented as a common bone ailment across England. Unfortunately, the scientifically proven cause of rickets was not identified until the 1920s, and by the 1930s, public-health initiatives recommended fortifying milk with vitamin D and cod-liver oil as a nutritional supplement for young infants and children. This led to a near eradication of rickets in the United States and other industrialized nations. Unfortunately, rickets has made a comeback and is still common in less-developed nations. Moreover, for a variety of reasons, rickets is seen more frequently amongst infants and children living in industrialized nations, often among more affluent populations. Medically Reviewed by a Doctor on 3/7/2016 Rickets: MedlinePlus Medical Encyclopedia Work indoors during the daylight hours You may not get enough vitamin D from your diet if you: Are lactose intolerant (have trouble digesting milk products) Do not drink milk products Follow a vegetarian diet Infants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D.

This can be a particular problem for darker-skinned children in winter months (when there are lower levels of sunlight). Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in diet is rare in developed countries, because calcium and phosphorous are found in milk and green vegetables. Your genes may increase your risk of rickets. Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis . Disorders that reduce the digestion or absorption of fats will make it more difficult for vitamin D to be absorbed into the body. Occasionally, rickets may occur in children who have disorders of the liver, or who cannot convert vitamin D to its active form. Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth, when the body needs high levels of calcium and phosphate. Rickets may be seen in children ages 6 to 24 months. It is uncommon in newborns.

Symptoms Urine calcium Treatment The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated to prevent the disease from returning. Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish, liver, and processed milk. Exposure to moderate amounts of sunlight is encouraged. If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed. Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require corrective surgery. Outlook (Prognosis) The disorder may be corrected by replacing vitamin D and minerals. Laboratory values and x-rays usually improve after about 1 week, although some cases may require large doses of minerals and vitamin D. If rickets is not corrected while the child is still growing, skeletal deformities and short stature may be permanent. If it is corrected while the child is young, skeletal deformities often improve or disappear with time. Possible Complications Skeletal fractures, may occur without cause When to Contact a Medical Professional Call your child's health care provider if you notice symptoms of rickets.

Prevention You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in the diet. People who have gastrointestinal or other disorders may need to take supplements. Ask your child's health care provider. Kidney (renal) causes of poor vitamin D absorption should be treated right away. People who have renal disorders should have their calcium and phosphorus levels monitored regularly. Genetic counseling may help people who have a family history of inherited disorders that can cause rickets. Alternative Names Osteomalacia in children; Vitamin D deficiency; Renal rickets; Hepatic rickets Images X-ray References Greenbaum LA. Rickets and hypervitaminosis D. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 48. Read More Overview - Rickets - Mayo Clinic Print Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. Vitamin D promotes the absorption of calcium and phosphorus from the gastrointestinal tract.

A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in bones, which can cause rickets. Adding vitamin D or calcium to the diet generally corrects the bone problems associated with rickets. When rickets are due to another underlying medical problem, your child may need additional medications or other treatment. Some skeletal deformities caused by rickets may require corrective surgery. Vitamin D Council | Vitamin D and rickets Rickets Summary Rickets is a condition that affects the development of bones in children. It causes soft weak bones, which can become bowed or curved. It’s a condition that only develops in children. It’s most commonly diagnosed in children between the age of 3 and 18 months. The main signs and symptoms of rickets include a misshaped or deformed skeleton, pain, fragile bones and poor growth and development. The most common cause of rickets is an extreme lack of vitamin D or a lack of calcium, or both together. The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. If your child doesn’t get enough of the minerals needed to make healthy strong bones, or enough vitamin D, the bones can’t form hard outer shells.

This is why they become soft and weak. The type of rickets that is caused by a lack of vitamin D and other minerals can be totally prevented by making sure your child gets enough vitamin D and calcium. Your baby can get the vitamin D he or she needs from your breast milk (as long as you’re getting good amounts yourself) or from formula milk with vitamin D added. However, if you don’t get good amounts of vitamin D yourself, your breast milk will not provide much vitamin D at all and require you to give your baby vitamin D supplements. Older children can take vitamin D supplements, or get vitamin D by exposing their skin to the sun. Research now shows that getting enough vitamin D during pregnancy is important for the health of your baby. If you’re pregnant you should consider taking a vitamin D supplement, particularly if you have darker skin or get little sunshine on your skin. Rickets can be effectively treated with vitamin D supplements. As well as giving vitamin D, doctors may also prescribe calcium supplements to treat rickets. What is rickets? Rickets is a condition that affects the development of bones in children. It causes soft weak bones, which can become bowed or curved. Rickets is a condition that affects the development of bones in children.

It causes soft weak bones, which can become bowed or curved. As you child grows up, his or her bones are continually growing and developing. How the bones develop, and how strong they are, depends on the amount of minerals such as calcium and phosphorus, that form the hard outer shell of the bones. This process is called mineralization. Calcium and phosphorus are absorbed from the food and drink your child has and end up in the bones. Your child needs vitamin D too, because it helps the body to use calcium properly, and makes sure it gets to where it’s needed (the bones or teeth). If your child doesn’t get enough of the minerals needed to make healthy strong bones, or enough vitamin D, the bones can’t form hard outer shells. They become soft and weak and as your child grows and gets heavier, the increase in their weight can cause the bones to become bowed, misshaped and deformed. If you child has rickets, then he or she is also more likely to develop infections such as pneumonia and gastroenteritis (infection of the stomach and bowel). 1 These can be very serious in babies and young children.

Babies and children with rickets may also be more likely to break (fracture) bones. 2 How common is rickets? The number of children that develop rickets in the US isn’t known. 3 However, research from the UK found that about 1 in every 100 non-Caucasian children has rickets. 4 Rickets is more common in children who have darker skin and in children who are breast fed rather than bottle fed. 5 Rickets is a condition that only develops in children. It’s most commonly diagnosed in children between the age of 3 and 18 months. 6 Adults can also develop soft bones. This condition is called osteomalacia. What are the symptoms of rickets? Rickets causes your child’s bones to become soft, weak and malformed, which can lead to bone deformities. The main signs and symptoms of rickets include: 7 A misshaped skeleton. This can include thickening of the ankles, wrists or knees (‘knock-knees’), legs that curve outwards (‘bow legs’) or a breastbone that sticks out (‘pigeon chest’) Pain.

The bones affected by rickets are often sore and painful, so your child may be reluctant to walk or may get tired easily. Fragile bones. The bones become weaker and are more likely to break. Poor growth and development. Your child’s skeleton doesn’t grow and develop properly, so he or she may be short for their age Problems with teeth, including weak tooth enamel and a delay in teeth coming through. Soft skull bones and a delay in the closing of the soft spot at the top of your baby’s head (the anterior fontanelle) What causes rickets? A severe lack of vitamin D or calcium or both can cause nutritional rickets. The most common cause of rickets is an extreme lack of vitamin D or a lack of calcium, or both together. 8 Vitamin D is produced naturally in your child’s body when bare skin is exposed to sunlight. Your child can also get vitamin D from most infant milk formulas, supplements and a small number of foods. Calcium comes from the food and drink your child has. Milk and dairy foods are a good source of calcium as well as some green vegetables, tofu, sardines and canned salmon.

Some foods such as soya and other non dairy milks, bread and breakfast cereals, have calcium added to them. Both calcium and vitamin D are essential for strong, healthy bones. If you breast feed your baby, and you don’t give a vitamin D supplement, then he or she is more likely to be lacking in vitamin D. When breastfeeding mothers don’t have high levels of vitamin D, their breast milk doesn’t contain much vitamin D and many breastfeeding women don’t get enough vitamin D themselves to pass on to their baby. Therefore children that are breastfed are more likely to develop rickets than children that are bottle fed (infant formula has vitamin D added to it). If your child eats a vegetarian or vegan diet, he or she may also be more likely to develop rickets, because they may not be getting enough calcium. 9 Rickets is more common in children with darker skins. 10 Children with African–American, Hispanic and Asian origins need to spend longer in the sun than children with fair skin to get the same amount of vitamin D. However, children with fair skin can also develop rickets if they don’t go outside in the sunlight very often, are frequently covered up or have sunscreen on all the time.

There are other types of rickets that are not caused by a lack of vitamin D or calcium, though these types of rickets are rare. Rickets can develop in children that have other health conditions such as liver disease, kidney disease or kidney failure. 11 There is also a type of rickets that is inherited (genetic). 12 These types of rickets are not treated with just vitamin D or calcium or both and need care from a doctor. What is the link between rickets and vitamin D? The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. In the late 19th and early 20th centuries, doctors realized that taking cod liver oil, which contains vitamin D, helped to prevent and treat rickets in children. In the 1930’s vitamin D was added to infant formula milk for the first time. Since then the number of children developing rickets has fallen dramatically and rickets has become a rare disease in the United States. However, rickets does still develop in some children and the numbers of children affected has started to rise. 13 The reasons why the number of children with rickets is rising aren’t clear.

It may be because doctors are better at diagnosing it, or because immigrants are moving away from the equator where there is more sun exposure or just more undetected rickets in general. 14 Vitamin D helps your body to control calcium and phosphate levels. If the blood levels of these minerals become too low, your body produces hormones that cause calcium and phosphate to be released from the bones, so it can have the right amount in the blood. This is what leads to soft and weak bones. When you get very little vitamin D (severe vitamin D deficiency), your body may not absorb enough calcium. Hormones may start taking too much calcium from your bones; hormones that vitamin D usually keeps under control. This makes your bones soft and weak and rickets develops. What does the research say about vitamin D and rickets? The links between vitamin D and rickets are very clear and have been known for a long time, so there has been quite a lot of research in this area, compared to some other conditions. There are also national guidelines for doctors on preventing rickets, produced by the Endocrine Society 15 and the American Academy of Pediatrics. 16 The Endocrine Society also produces guidelines on the treatment of rickets.

Preventing rickets Research has shown that the type of rickets that is caused by a lack of vitamin D and other minerals can be totally prevented by making sure your child gets enough vitamin D and calcium. 17 Vitamin D for babies and children To develop their guidelines on preventing rickets, The American Academy of Pediatrics searched for all of the research carried out in the US, and the rest of the world, about rickets and vitamin D. Having looked at all the research and analysed it, the Academy has said that to prevent rickets, infants, children and adolescents need to have at least 400 IU of vitamin D a day. They recommend that: Babies that are being breastfed or partly breastfed should have a vitamin D supplement of 400 IU a day. Babies should keep having a supplement until they are drinking at least one litre of whole milk or formula milk a day (children shouldn’t drink whole milk until they are over one year old). All babies and children drinking less than one litre of infant formula or whole milk a day should also take a supplement of 400 IU of vitamin D each day.

Adolescents who don’t get enough vitamin D from fortified milk or foods should take a vitamin D supplement of 400 IU a day. Giving babies and children vitamin D supplements has been preventing rickets for many years. However, there isn’t much research that has looked at whether the amount that babies and children are given is actually the right amount. For example, doctors used to recommend that babies and children should have 200 IU vitamin D a day to prevent rickets, and this worked. 18 Guidelines in Canada recommend that babies should be given 400 IU a day, but that this should with increase to 800 IU a day in the winter months for babies living in the north of the country. 19 The Endocrine Society in the US recommends that infants and children should have 400IU or 600 IU of vitamin D a day, and that to get the best effect from vitamin D, they may need as much as 1,000 IU a day.

20 What the Vitamin D Council says The Vitamin D Council recommends that infants have 1,000 IU per day and children have 1,000 IU a day per 25lbs of their body weight. Breast milk can provide most or all of this for infants, if the mother is getting enough vitamin D herself. If she isn’t, then breast milk cannot provide much of the 1,000 IU a day requirement. See our breastfeeding page for more information. More research is needed to say exactly how much vitamin D is needed to prevent rickets. However, that research may never come. Something else that researchers and doctors also have to take into account is whether the amount of vitamin D children get is enough to meet other health needs, as well as to prevent rickets. The amount of vitamin D children need for other health reasons may be higher than what is needed to prevent rickets, though again, more research is needed. Vitamin D in pregnancy Some researchers have explored whether the amount of vitamin D a mother gets when she is pregnant may help to prevent rickets in her child. How much vitamin D a woman has in her body decides how much vitamin D her baby will have when he or she is born.

If you’re very deficient (lacking) in vitamin D when you’re pregnant, then your child is more likely to develop rickets. 21 Women who have darker skin and women who don’t expose their skin much to the sun are more likely to be deficient in vitamin D. 22 Research now shows that getting enough vitamin D during pregnancy is important for the health of your baby. 23 Therefore, the American Academy of Paediatrics recommends that doctors and midwives should consider giving vitamin D supplements to pregnant women who might be deficient. 24 The Endocrine Society and the Vitamin D Council suggest that all pregnant women need to take vitamin D supplements. Vitamin D and calcium Researchers have also explored the role of calcium and vitamin D in preventing rickets. Vitamin D helps calcium to work properly in your body and your body needs both to develop strong healthy bones. Research shows that babies and children who don’t get enough calcium from the food and milk they have, are more likely to develop rickets. 25 Treating rickets If your child has rickets, your doctor may choose to treat your child’s rickets with a one-time vitamin D supplement or a daily supplement.

Rickets has been treated successfully with vitamin D since at least the 1930s, when doctors gave children one very large amount of vitamin D to treat the condition. 26 Now, there is agreement among doctors that rickets should be treated with vitamin D supplements. This can either be given as one large amount, as weekly amounts or as small amounts given every day for two to three months. 27 More recent research has also looked at whether giving children a large amount of vitamin D just once is effective at treating rickets. Researchers have given children large amounts such as 200,000 or 600,000IU vitamin D in one day and found that it was a safe and effective treatment. 28 , 29 This type of treatment is called Stoss Therapy. Some scientists suggest that rickets should be treated with 5,000 to 15,000 IU of vitamin D a day for three to four weeks and then a smaller dose thereafter. 30 Talk to your doctor about which type of treatment is best for your child; one large supplement, weekly or daily supplements. As well as giving vitamin D, doctors may also prescribe calcium supplements to treat rickets.

31 Key points from research The links between vitamin D and rickets are very clear and have been known for a long time. There are many national guidelines, including a number in the US, which tell doctors how to prevent rickets. These guidelines have been developed by reading and analyzing all of the research on vitamin D and rickets. Rickets can be prevented by making sure your child gets enough vitamin D and calcium. Babies that are breastfed or partly breastfed should be given a vitamin D supplement, unless the breastfeeding mother gets good amounts of vitamin D herself. Doctors and researchers haven’t come to a definite answer about how much vitamin D supplement is enough to prevent rickets and ensure good bone health. However, it is likely at least 400 IU a day. It’s important for the health of a baby for the mother to get enough vitamin D while she is pregnant. Research suggests that women who are more likely to be deficient in vitamin D during their pregnancy should take a vitamin D supplement to prevent rickets in their child. Babies and children who don’t get enough calcium from the food and milk they have, are more likely to develop rickets Rickets can be treated successfully with vitamin D, calcium or sometimes both.

What does this mean for me? Good vitamin D and calcium nutrition can prevent nutritional rickets and help your child grow strong and healthy. If you’re pregnant you should consider taking a vitamin D supplement, particularly if you have darker skin or get little sunshine on your skin. The Vitamin D Council recommends taking 4,000 IU to 6,000 IU of vitamin D every day if you’re pregnant. Other organizations in the United States have set different recommended daily amounts, usually much lower. For example, the Food and Nutrition Board recommend 600 IU of vitamin D every day because they feel there is not enough research at this time to recommend higher amounts. You can find out more about vitamin D when you’re pregnant by going to our Vitamin D during pregnancy and breastfeeding page . If you’re breastfeeding your baby, either fully or in part, you may need to give your baby a vitamin D supplement every day. If you’re getting enough vitamin D, your baby should be getting enough vitamin D from your milk. However, many women don’t get enough vitamin D and if that is the case, you will need to give your baby a supplement. Not all organizations recommend the same amount of supplement for babies each day.

Here is a list of the current recommendations from organizations in the United States: Vitamin D Council 1,000 IU/day* Endocrine Society 400-1,000 IU/day Food and Nutrition Board 400 IU/day You can find out more about vitamin D when you’re breastfeeding by going to our Vitamin D during pregnancy and breastfeeding page . If you’re giving your baby only infant formula, which contains vitamin D, you may not need to give a supplement. Older children and adolescents also need enough vitamin D to keep their bones healthy and prevent rickets. If your child isn’t able to get vitamin D from being out in the sun, you should give him or her vitamin D supplements. You can find out more by going to our Vitamin D during pregnancy and breastfeeding page . References Y Cesur, M Dogan, S Ariyuca etc al. Evaluation of children with nutritional rickets. J Pediatr Endocr Met 2011;24(1-2):35-43 Winzenberg T, Jones G. Vitamin D and bone health in childhood and adolescence.

Calcif Tissue Int (2013) 92:140-150 Thatcher T, Fischer P, Tebben P et al. Increasing Incidence of Nutritional Rickets: A population-based study in Olmsted County Minnesota. Mayo Clinic Proc 2013; 88(2):176-183 Ashraf S, Mughal MZ ; The prevalence of rickets among non-Caucasian children. Arch Dis Child. 2002 Sep;87(3):263-4. Rickets. eMedicine. Shah BR, Finberg L. Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr. Sep 1994;125(3):487-90. Billoo AG, Murtaza G, Memon MA et al. Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets, J Coll Physicians Surg Pak. 2009: 19: 428-431. Pettifor JM. Vitamin D Deficiency and Nutritional Rickets in Children.

In Vitamin D: Third Edition by Feldman D, Pike JW and Adams JS. Elsevier Academic Press, 2011. Rickets. American Academy of Orthopaedic Surgeons. This page in PDF format Are you a health care provider? Print and share this PDF file to your patients: This page was last updated August 2014. We need your help! Rickets, Caused by Vitamin D Deficiency, Makes a Comeback | The Weather Channel Rickets, Caused by Vitamin D Deficiency, Makes a Comeback By MARIA CHENG, AP Medical Writer Published undefined NaN 0NaN NaN:NaN PM EST Associated Press (Thinkstock) LONDON (AP) — Rickets, the childhood disease that once caused an epidemic of bowed legs and curved spines during the Victorian era, is making a shocking comeback in 21st-century Britain. Rickets results from a severe deficiency of vitamin D, which helps the body absorb calcium. Your body makes vitamin D after exposure to sunlight, and it's also available through food.

Rickets was historically considered to be a disease of poverty among children who toiled in factories during the Industrial Revolution, and some experts have hypothesized it afflicted literary characters like Tiny Tim in Charles Dickens' "A Christmas Carol." Last month, Britain's chief medical officer, Dr. Sally Davies, described the return of rickets as "appalling." She proposed the country give free vitamins to all children under 5 and asked the country's independent health watchdog to study if that would be worthwhile. Most people get vitamin D from the sun, oily fish, eggs or dairy products. Rickets largely disappeared from Britain in the 1950s, when the country embarked on mass programs to give children cod liver oil. But in the last 15 years, the number of reported cases of rickets in hospitalized children has increased fourfold — from 183 cases in 1995 to 762 cases in 2011. Experts said the actual number is probably even higher since there's no official surveillance system and it's unknown whether the disease has peaked. Rickets: Causes, Symptoms and Treatments - Medical News Today Rickets: Causes, Symptoms and Treatments Written by Stephanie Brunner B.A.

4 16 Rickets is a childhood bone disorder in which bones soften and become prone to fractures and deformity. Although rare in industrialized nations, it is still fairly common in some developing countries. The main cause of rickets is a lack of vitamin D . Not having enough calcium in one's diet may also be a cause of rickets, as may vomiting and diarrhea . Some childhood kidney and liver diseases can cause rickets, as may a digestive disorder complication that affects calcium and phosphorous absorption. Rickets affects mainly children, although the disorder may also affect adults (osteomalacia). In most cases, the child suffers from severe and long-term malnutrition , usually during early childhood. The term rickets comes from the Old English word "wrickken", meaning to twist or bend. Rickets was common in the UK and USA during the 19th century. For proper absorption of calcium and phosphorous from the gut, we need vitamin D. If vitamin D levels in a child are low, he/she may have inadequate calcium and phosphorous bone levels.

A study published in JAMA in 2013 suggested that babies should be given a daily dose of vitamin D of 400 IU (international units) to help them stay healthy . Providing a child with extra vitamin D and some minerals usually resolves the rickets problem. Symptoms of rickets A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Symptoms of rickets may include: Baby is floppy Causes of rickets Some of the conditions that can be caused by vitamin D deficiency. Lack of vitamin D - the main cause of rickets. Our bodies need vitamin D in order to absorb calcium from the intestines. Ultraviolet light (from sunlight) helps our skin cells convert vitamin D from an inactive into an active state. If we do not have enough vitamin D, calcium that we get from the food we eat is not absorbed properly, causing hypocalcemia (lower-than-normal blood calcium) to develop. Hypocalcemia results in deformities of bones and teeth, as well as neuromuscular problems.

The following foods are known to be rich on vitamin D: eggs, fish oils , margarine, some fortified milks and juices, some oily fishes, and some soymilk products that have vitamin D added. Genetic defect - hypophosphatemic rickets is a rare genetic fault that undermines the way the kidneys process phosphates. Phosphate blood levels are too low, leading to weak and soft bones. Some diseases - some renal (kidney), hepatic (liver) and intestinal diseases can interfere with the way the body absorbs and metabolizes minerals and vitamins, resulting in rickets. Risk factors for rickets Vitamin D is described as the sunshine vitamin. A study published in the journal Pharmacology and Pharmacotherapeutics in 2012 suggested that 50% of the worldwide population may be deficient in vitamin D ( source ). A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Risk factors for rickets include: Poverty - rickets is more likely to occur among children who are poor.

Sunlight - children who do not get enough sunlight are more dependent on excellent nutrition to make sure they are getting enough vitamin D. Malnutrition - rickets is more common in areas of the world where severe droughts and starvation occur. On the next page we look at the diagnosis of rickets, complications caused by the condition and the available treatments for rickets. Rickets and osteomalacia - Causes - NHS Choices Rickets and osteomalacia - Causes Rickets Prevention Causes of rickets Rickets usually occurs because of a lack of vitamin D or calcium, although it can also be caused by a genetic defect or another health condition. Lack of vitamin D and calcium The most common cause of rickets is a lack of vitamin D or calcium in a child's diet. Both are essential for children to develop strong and healthy bones. Sources of vitamin D are: sunlight – your skin produces vitamin D when it's exposed to the sun, and we get most of our vitamin D this way food – vitamin D is also found in some foods, such as oily fish, eggs and fortified breakfast cereals dietary supplements Calcium is commonly found in dairy products, such as milk, cheese and yoghurt, and green vegetables, such as broccoli and cabbage.

Over time, a vitamin D or calcium deficiency will cause rickets in children and soft bones (osteomalacia) in adults. See preventing rickets for more information and advice about ensuring your child gets enough vitamin D and calcium. Who's at risk? Any child who doesn't get enough vitamin D or calcium can develop rickets, but there are certain groups of children who are more at risk. For example, rickets is more common in children of Asian, African-Caribbean and Middle Eastern origin because their skin is darker and needs more sunlight to get enough vitamin D. Babies born prematurely are also at risk of developing rickets because they build up stores of vitamin D while they're in the womb. Babies who are exclusively breastfed, especially for longer than six months, may also be at risk of vitamin D deficiency.

This is why the Department of Health recommends that: pregnant and breastfeeding women should consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D babies from birth to one year of age, whether exclusively or partially breastfed, should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough babies fed infant formula do not need a vitamin D supplement until they are receiving less than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D children aged 1 to 4 years old should be given a daily supplement containing 10mcg of vitamin D For more information, read who should take vitamin D supplements . Genetic defect Rare forms of rickets can also occur in some inherited (genetic) disorders. For example, hypophosphatemic rickets is a genetic disorder where the kidneys and bones deal abnormally with phosphate. Phosphate binds to calcium and is what makes bones and teeth hard. This leaves too little phosphate in the blood and bones, leading to weak and soft bones. Other types of genetic rickets affect certain proteins in the body that are used by vitamin D.

Underlying conditions Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption of vitamins and minerals. Page last reviewed: 21/12/2015 Rickets, Vitamin D Deficiency - NORD (National Organization for Rare Disorders) Rickets, Vitamin D Deficiency Synonyms of Rickets, Vitamin D Deficiency Nutritional Rickets Vitamin-D Deficiency Rickets General Discussion Vitamin-D deficiency rickets, a disorder that becomes apparent during infancy or childhood, is the result of insufficient amounts of vitamin D in the body. The vitamin deficiency may be caused by poor nutrition, a lack of exposure to the sun, or malabsorption syndromes in which the intestines do not adequately absorb nutrients from foods. Vitamin D is needed for the metabolism of calcium and phosphorus in the body, which, in turn affects how calcium is deposited in the bones; thus it is considered essential for proper bone development and growth. Major symptoms of vitamin D deficiency rickets include bone disease, restlessness, and slow growth. This disorder is rare in the United States but is not uncommon in certain areas of the world.

Signs & Symptoms Symptoms of vitamin D deficiency rickets in infants may be restlessness, lack of sleep, slow growth, a delay in crawling, sitting or walking, thinness of the top and back of the skull (craniotabes), swelling of the skull (bossing), bead-like nodules where the ribs and their cartilages join due to the rapid growth of the arms and the rib cage (rachitic rosary), and a delay in the closing of the skull bone. Some doctors describe the symptoms of rickets as aches and pains and possible enlarged bones along with swelling at the joints such as wrists and ankles. If vitamin D deficiency rickets is not treated, the ends of the long bones may become enlarged, the legs may become bowed and knock-knees may result. Muscles can become weak and the chest may become deformed due to the pull of the diaphragm on the ribs that have been weakened by rickets (Harrison’s groove). Abnormal development and decay of teeth may also occur. In more severe, untreated cases of this disorder the bones may become fragile and fractures may easily occur.

Convulsions, muscle twitching and sharp bending of the wrist and ankle joints (tetany spasms) may also be present. Occasionally, when there is too little calcium in the blood due to the lack of vitamin D (hypocalcemia), mental retardation may occur. Causes Vitamin D deficiency rickets can be caused by a lack of vitamin D in the diet, a lack of exposure to the sun, or malabsorption syndromes in which there is an inability of the intestines to adequately absorb nutrients from foods. Nursing mothers who have a diet deficient in vitamin D may get rickets themselves and pass this condition on to the newborn child. In areas of the world where cultural habits limit exposure to sun, or the amount of sun in a day or season is limited, Vitamin D deficiency rickets tends to be more prevalent. Affected Populations Vitamin D deficiency rickets affects males and females in equal numbers. Babies of nursing mothers whose diet is deficient in vitamin D can be affected with this disorder. Although vitamin D deficiency rickets is rare in the United States, children who are dark skinned and living in cloudy northern cities as well as children on restricted diets due to cultural or religious beliefs are more likely to develop this disorder.

Rickets is more common in regions of Asia where there is a lack of daylight and/or low intake of meat due to a vegetarian diet. Northern Yemen and Kuwait are also areas where Vitamin D deficiency rickets are prevalent due to lack of exposure to the sun because of cultural practices. Related Disorders Symptoms of the following disorders can be similar to those of vitamin D deficiency rickets. Comparisons may be useful for a differential diagnosis: Fanconi’s syndrome is a rare disorder characterized by kidney dysfunction and bone abnormalities similar to those of vitamin D deficiency rickets. Excess amounts of phosphate, amino acids (usually bicarbonate), glucose, and uric acid are eliminated in the urine. This disorder may be acquired through various causes or inherited as an autosomal recessive or, when associated with Lowe’s syndrome, an x-linked recessive genetic trait. Bone symptoms include rickets in children and softening of the bones (osteomalacia) in adults. Fanconi’s syndrome may be associated with a variety of inherited metabolic disorders such as cystinosis, Lowe’s syndrome, a form of ryrosinemia, hereditary fructose intolerance, Wilson’s disease, galactosemia and glycogen storage disorders.

(For more information on this disorder choose “Fanconi” as your search term in the Rare Disease Database.) Infantile scurvy is a disease that is caused by a lack of vitamin C in the diet. Symptoms of this disorder may be anemia, weakness, sores in the mouth, loosening of the teeth, irritability, loss of appetite, failure to gain weight and bleeding under the tissue layer covering the bones. Scurvy is treated with large amounts of vitamin C . Lowe’s syndrome is a rare inherited, metabolic disorder characterized by eye abnormalities such as congenital cataracts and glaucoma, bone malformations caused by vitamin D resistant rickets, mental retardation and impairment of kidney function. This disorder affects only males and is most common in those with fair coloring. Lowe’s Syndrome is transmitted through x-linked recessive genes. (For more information on this disorder choose “Lowe” as your search term in the Rare Disease Database.) Osteomalacia is a disorder characterized by a gradual softening and bending of the bones. Pain may occur in various degrees of severity. Softening occurs because solid bones have failed to form properly (calcify) due to the lack of vitamin D or a kidney dysfunction.

This disorder is more common in females than males, and often begins during pregnancy. It can exist alone or in association with other disorders. Hypophosphatemic rickets is a rare genetic form of rickets characterized by impaired transport of phosphate and diminished vitamin D metabolism in the kidneys. Calcium and phosphate are not absorbed properly in the intestines which can lead to softening of bones. Major symptoms of this disorder include skeletal changes, weakness and slow growth. Cases affecting females are usually less severe than those affecting males. One rare acquired form of this disorder may be associated with a benign tumor. (For more information on this disorder choose “Hypophosphatemic Rickets” as your search term in the Rare Disease Database.) Pseudovitamin D deficiency rickets (vitamin D dependent rickets, type I) is characterized by more severe skeletal changes and weakness than those of hypophosphatemic rickets. This disorder is caused by abnormal vitamin D metabolism and is inherited as an autosomal recessive trait. This type of rickets often begins earlier than hypophosphatemic rickets. Blood levels of calcium are severely diminished in patients with vitamin D dependent rickets. Amino acids become lost in the urine due to abnormal kidney function.

Intermittent muscle cramps may occur. Convulsions and abnormalities of the spine and pelvis may also develop. Diagnosis In children, the suspected joints are X-rayed and characteristic changes in the bone may be detected. Blood tests to determine the levels of calcium and phosphorus will be undertaken as well. A bone biopsy is performed in difficult cases. Vitamin D deficiency rickets can be prevented by providing a normal balanced diet to infants and children, assuming that they are exposed to adequate amounts of sun. Standard Therapies Treatment Treatment of vitamin D deficiency rickets is accomplished with doses of vitamin D given daily until the bone disease is cured. The dose of vitamin D can then be reduced to the daily recommended requirement. In more severe cases of vitamin D deficiency rickets when cramps, convulsions, muscle twitching and sharp bending of the ankle and wrist joints (tetany) is present the treatment with vitamin D is supplemented with calcium salts intravenously. In some instances surgery may be required to correct distortions of bone and muscle. Investigational Therapies Information on current clinical trials is posted on the Internet at All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office: Tollfree: (800) 411-1222 References TEXTBOOKS Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:35-38. Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:894. Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:896-97. Bennett JC, Plum F. Eds. Cecil Textbook of Medicine. 20th ed. W.B. Saunders Co., Philadelphia, PA; 1996:1359-65. REVIEW ARTICLES Collier S, Fulhan J, Duggan C. Nutrition for the pediatric office: update on vitamins, infant feeding, and food allergies.

Curr Opin Pediatr. 2004;16:314-20. Reginato AJ, Coquia JA. Musculoskeletal manifestations of osteomalacia and rickets. Best Pract Res Clin Rheumatol. 2003;17:1063-80. Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr. 2004;79:717-26. Molgaard C, Michaelsen KF. Vitamin D and bone health in early life. Proc Nutr Soc. 2003;62:823-28. Berg EE. Rickets. Orthop Nurs. 2004;23:53-55. Specker B. Nutrition influences bone development from infancy through toddler years. J Nutr. 2004;134:691S-695S. Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003;78:912-19.

Wharton B, Bishop N. Rickets. Lancet. 2003;362:1389-400. Gartner LM, Greer FR, et al. Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake. Pediatrics. 2003;111:908-10. FROM THE INTERNET Years Published 1992, 1995, 2005 The information in NORD’s Rare Disease Database is for educational purposes only and is not intended to replace the advice of a physician or other qualified medical professional. The content of the website and databases of the National Organization for Rare Disorders (NORD) is copyrighted and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from NORD. Individuals may print one hard copy of an individual disease for personal use, provided that content is unmodified and includes NORD’s copyright.

National Organization for Rare Disorders (NORD) 55 Kenosia Ave., Danbury CT 06810 • (203)744-0100 Report Index Vitamin D Deficiency and Rickets - HealthyChildren.org Vitamin D Deficiency and Rickets Page Content ​ ​What is rickets? Rickets is a condition of softening of the bones that occurs in growing children. It happens when the bones can not take up enough calcium and phosphorus to make hard, healthy bone. Although there are genetic and metabolic causes of rickets, the most common cause is a lack of vitamin D . This is also called nutritional rickets. What is vitamin D? Vitamin D is a substance that the body needs to help absorb calcium from the gut and regulate how much calcium and phosphorus gets stored in the bone and how much gets let out of the body in urine by the kidneys. Vitamin D can be obtained by eating certain types of fatty fish and fish oils, but it is also made in the skin in response to ultraviolet rays of sunlight. However, one must be exposed to the right wavelength of sunlight for a substantial period of time to make enough vitamin D for bone health.

The use of sunscreen (which is, of course, important in preventing sunburn and skin cancer ) does not allow the body to make much vitamin D in the skin. For this reason, in the United States and many industrialized nations, cow milk (and infant formula ) is fortified with extra vitamin D. Human milk is often very low in vitamin D. What are the symptoms of rickets? The most classic symptom of rickets is bending or " bowing " of the bones of the legs. This happens because of the stress of walking on "soft" bones that do not have enough minerals. Infants who are crawling but not walking yet can get widening of the area just above the wrists for the same reason. In more severe cases, one can see swelling of the ends of the ribs as well. Sometimes the blood level of calcium can become so low that seizures can develop. How is rickets diagnosed? A physician can diagnose rickets from a combination of physical exam findings, x-rays (which show widening and "fraying" of the ends of certain long bones), and blood tests that can show low levels of phosphorus and normal or low calcium with an elevated level of an enzyme called alkaline phosphatase.

Your doctor may also check the level of "25 hydroxy" vitamin D. On occasion, further blood testing is necessary to diagnose other forms of rickets. Who is at risk for nutritional rickets? Infants who are breastfed and who are not given extra vitamin D are at highest risk. The risk is even greater if the baby's mother is also vitamin D deficient. Vitamin D deficiency among women of childbearing age is quite common. It occurs even more often in dark-skinned people and people who do not expose themselves to much sunlight. How can rickets be prevented? All breastfed infants should receive 400 international units of vitamin D daily. This can be obtained in a standard dose of infant vitamin drops (which usually contain vitamins A, D, and C). Nursing women should make sure that they take in at least 600 units of vitamin D daily. Many sources recommend 1500 to 2000 units daily. How is nutritional rickets treated? Treatment requires high doses of either ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) to build up the body stores of the vitamin.

The standard regimen is about 2000 to 4000 units daily for several months. It can vary based on the size and age of the child being treated. Some physicians use other regimens. It is helpful to note that some forms of vitamin D (especially the liquid) can be expensive when obtained through a pharmacy and not covered by insurance. These preparations are available on the Internet at a cheaper cost. However, please check with your physician before ordering on the Internet by yourself. Supplemental calcium is also needed to keep the blood calcium level normal and heal the bones if the dietary intake of calcium is not sufficient. If the treatment is adequate, the x-ray changes start to resolve and the blood alkaline phosphatase normalizes in about 6 to 8 weeks. If bowing of the legs has developed, it can take many months to straighten out, but it usually does improve.

Question: Rickets is caused by a deficiency in which vitamin?
Answer: D