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 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 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 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. So rickets is back.

Blame poverty, not a lack of sun | Barbara Ellen | Opinion | The Guardian So rickets is back. Blame poverty, not a lack of sun The shocking figures for vitamin D deficiency can only be blamed on rising poverty and its evil twin, malnourishment Saturday 15 December 2012 19.06 EST First published on Saturday 15 December 2012 19.06 EST Share on Messenger Close Did you hear about rickets making a comeback ? Rickets! How did that happen? Should we start painting crosses on doors, put our deceased onto wooden carts, get right back into the dark ages? When I was growing up, adults occasionally muttered about rickets, but it already had a faraway, almost medieval air. Or it was something that happened to undernourished 18th-century workhouse mites? Better postwar nutrition had all but seen it off, depositing it on the list of ailments of yore, along with smallpox and the bubonic plague. A case of bye-bye rickets, and good riddance. Well, not any more.

Cases of rickets have risen fourfold since studies from the mid-1990s (from 183 to 762). Moreover, the Royal College of Paediatrics and Child Health (RCPCH) reports that half of Britain's white population, up to 90% of the multiethnic population, and a quarter of children, are suffering from vitamin D deficiency, the main cause of rickets. The RCPCH proposes that food should be fortified with vitamin D to reach children and other vulnerable groups, and for greater general awareness. Fair enough, but is this just an awareness-raising issue, or also about politics and poverty? It doesn't help that vitamin D deficiency is complex. No one seems to know why there is such a high incidence among certain ethnic groups. There has been debate about burqas but they are only being worn by females of certain groups, and after the age of 13. Elsewhere, parents don't suncream their mollycoddled kids all year round!

(It's a miracle if they even remember on hot days.) Similarly, even if you're not vegan, it's said to be impossible to get enough vitamin D from food – but is this any more true in 2012 than in the past? Nor does the sun seem less available now than in the mid-90s (climate change would suggest the opposite). So, why rickets in Britain, and why now? Well, call me paranoid, but it seems probable that vitamin D deficiency is part of a wider cultural malaise, emanating from rising poverty and its evil twin, malnourishment, leading to all-encompassing vitamin deficiency, not just vitamin D. Families on benefits are supposed to get free vitamins but the RCPCH say that, while the take-up is poor, supplies are also low. Elsewhere, it's just been announced that Britain has slipped another couple of notches on the European living standards chart. Then there's the 2011 Family Food survey , which says that, since the recession, people are buying 10%-20% less fruit and vegetables, and much less fresh milk, bread, and fish.

Meanwhile, the Children's Society reports that 72% of teachers it surveyed see children who have not only skipped breakfast but also have no lunch or the means to pay for one. In many cases, teachers are paying for pupils' food, so they are not hungry in class. This is just one week's worth of reports. A picture is forming, and that picture does not seem a million brush strokes away from the inglorious rise of rickets, and widespread vitamin deficiency. Nor does it seem likely that lack of public awareness is the only issue, or even the main one. For struggling recession-hit families, skirting nourishment isn't a lifestyle choice. Nor are these people too dumb to know what's required for good health. Such decisions are clearly being made on economic grounds. Certainly, it has to be shaming that, in the era of the smartphone and the Heston Christmas pud, society is regressing back to 18th-century diseases that were sent packing back when Britain had barely put its ration book away. Indeed, anyone in government now must feel wonderfully proud to see the rise of rickets on their watch. So, rickets again – how did that happen?

It seems that the only sane answer is: exactly the same way it did before. Strictly speaking, it's unfair to call Denise a cheat It's about time Chris Evans apologised to Denise Van Outen for coming out with that codswallop about her "experience" giving her an unfair advantage on Strictly Come Dancing. To put the kind of modern dance Van Outen encountered as a young pupil at Sylvia Young in the same bracket as ballroom is risible. Likewise, Van Outen's Roxie Hart in Chicago had one big number but no pairings, while her other West End parts involved zilch dancing. Or did Tell Me on a Sunday's original star, Marti Webb, sneak in the odd paso doble when the audience were rustling in their Maltesers boxes? Sure, it's only a show, but an issue of fairness lurks beneath the sequins. Strictly has given X Factor a distinctly inelegant kicking in the ratings for some time. Producers have their pick of contestants and would spot a cheat who can already dance. As it is nearing the final, Van Outen could be out for no good reason.

Moreover, she's being made to look petulant and guilty as she tries to explain when, actually, it's the truth. The problem was not Van Outen's "unfair experience", rather Evans's ill-informed gob. Not strictly fair, Mr Evans. Put a cork in it, you red wine poseurs You might need a drink before you read this (gerrit dahn yer!). A report from France's Wines With Style website claims that the colour of wine you favour reveals your personality and social status. However, it's biased in favour of red aficionados, who are said to be confident, adventurous high earners. Well, get them. Meanwhile, white fans are under-achieving bores. Thanks. And rosé drinkers are barely educated idiots who are always checking their Facebook. Well, we all knew that. What a crock. This study does not take into account the people who drink everything. Nor the flippers who change allegiance, for whatever reason: in my case, age-related super-hangovers, which are vicious to a huge degree. Try to imagine waking up with a griffin eating your head. In the spirit of full disclosure, I also dilute the wine with sparkling water. Yes, I know.

This exposes me as so feeble and past it perhaps someone should take my pulse because I may actually have died a few years ago. Despite these harrowing revelations, it's my firm belief that, past a certain age, red wine is the tipple of the secretly pathetic. Have you seen older people drinking red wine – all that posing, swirling and droning about "the bouquet"? All this to disguise the fact that they're not actually drinking any of it. They are fake drinking, Meanwhile, the likes of me sit there with our tragic white wine-cum-Highland Spring concoctions, as if to say: "I'm too old to binge drink, but I'm giving it my best shot." It might not be pretty, but it's honest. Compared to this, most red wine drinkers are a bunch of lying sissies – dare I say, just the sort of people who would cravenly fib to wine companies in studies. Vitamin D Deficiency including Osteomalacia and Rickets | Health | Patient Vitamin D Deficiency including Osteomalacia and Rickets Vitamin D Deficiency including Osteomalacia and Rickets 604 Vitamin D is important for good health, growth and strong bones.

A lack of vitamin D is very common. Vitamin D is mostly made in the skin by exposure to sunlight. Most foods contain very little vitamin D naturally, though some are fortified (enriched) with added vitamin D. A mild lack of vitamin D may not cause symptoms but can cause tiredness and general aches and pains. A more severe lack can cause serious problems such as rickets (in children) and osteomalacia (in adults), described below. Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely. These include all pregnant and breast-feeding women, all babies and young children aged 6 months to 5 years, people aged 65 and over, and people who are not exposed to much sun. A doctor may also recommend routine supplements for certain people with darker skin, and for people with certain gut, liver or kidney diseases. What is vitamin D? Vitamin D is a vitamin that is needed for good health. Unlike other vitamins, we do not need to get vitamin D from food. A main source of vitamin D is made by our own bodies. It is made in the skin by the action of sunlight.

This is a good thing because most foods contain no or very little vitamin D naturally. Foods that contain vitamin D include: Oily fish (such as sardines, pilchards, herring, trout, tuna, salmon and mackerel). Fortified foods (this means they have vitamin D added to them) such as margarine, some cereals, infant formula milk. The best dietary source of vitamin D is oily fish and cod liver oil. There is little or no vitamin D in UK milk and dairy products. Only infant formula milk and margarine have statutory vitamin D supplementation in the UK. Egg yolk, liver, and wild mushrooms contain only small quantities of vitamin D. Vitamin D and sunlight Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D. For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK. However, for people with darker skin and the elderly, the amount of time needed exposed to sunlight to make enough vitamin D can be much more than this.

Note: it is not the same as sunbathing; the skin simply needs to be exposed to sunlight. But, the sunlight has to fall directly on to bare skin (through a window is not enough). For six months of the year (October to April), much of western Europe (including 90% of the UK) lies too far north to have enough UVB rays in sunlight necessary to make vitamin D in the skin. So, many people in the UK are at risk of not getting enough vitamin D unless they get it in their diet. Note: too much exposure to the sun's rays can be damaging. Sunburn should be avoided at all costs (mainly because it can increase your risk of skin cancer). Why do we need vitamin D? A main action of vitamin D is to help calcium and phosphorus in our diet to be absorbed from the gut. Calcium and phosphorus are needed to keep bones healthy and strong. So, vitamin D is really important for strong and healthy bones. In addition, vitamin D seems to be important for muscles and general health. There is also some evidence that vitamin D may also help to prevent other diseases such as cancer, diabetes and heart disease. Who gets vitamin D deficiency?

Vitamin D deficiency means that there is not enough vitamin D in your body. Broadly speaking, this can occur in three situations: The body has an increased need for vitamin D. The body is unable to make enough vitamin D. Not enough vitamin D is being taken in the diet. Increased need for vitamin D Growing children, pregnant women, and breast-feeding women need extra vitamin D because it is required for growth. So, vitamin D deficiency is more likely to develop in the following groups of people: Pregnant or breast-feeding women. Vitamin D deficiency is even more likely to develop in women who have had several babies with short gaps between pregnancies. This is because the body's stores of vitamin D get used up, and there is little time for them to be built up before another pregnancy. Breast-fed babies whose mothers are lacking in vitamin D, or with prolonged breast-feeding, as there is little vitamin D in breast milk. (Note: there are significant advantages to breast-feeding.

You should not stop breast-feeding due to concern about vitamin D levels - your baby can simply have vitamin D supplements as drops by mouth.) Where the body is unable to make enough vitamin D This can occur for various reasons: People who get very little sunlight on their skin are at risk of vitamin D deficiency. This is more of a problem in the more northerly parts of the world (including the UK) where there is less sun. In particular: People who stay inside a lot. For example, those in hospital for a long time, or housebound people. People who cover up a lot of their body when outside. Strict sunscreen use can potentially lead to vitamin D deficiency, particularly if high sun protection factor (SPF) creams (factor 15 or above) are used. Nevertheless, children especially should always be protected from the harmful effect of the sun's rays and should never be allowed to burn or be exposed to the strongest midday sun. Elderly people have thinner skin than younger people and so are unable to produce as much vitamin D. This leaves older people more at risk of vitamin D deficiency. People who have darker skin.

For example, people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. Some medical conditions can affect the way the body handles vitamin D. People with Crohn's disease , coeliac disease , and some types of liver and kidney disease, are all at risk of vitamin D deficiency. Rarely, some people without any other risk factors or diseases become deficient in vitamin D. It is not clear why this occurs. It may be due to a subtle metabolic problem in the way vitamin D is made or absorbed. So, even some otherwise healthy, fair-skinned people who get enough sun exposure can become deficient in vitamin D. Vitamin D deficiency can also occur in people taking certain medicines. Examples include: carbamazepine , phenytoin , primidone , barbiturates and some anti-HIV medicines . Not enough dietary vitamin D Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet. How common is vitamin D deficiency? It is very common. A recent survey in the UK showed that more than half of adults in the UK did not have enough vitamin D.

In the winter and spring about 1 in 6 people have a severe deficiency. It is estimated that about 9 in 10 adults in the UK of South Asian origin may be vitamin D-deficient. Most affected people either don't have any symptoms, or have tiredness or vague aches and pains, and are unaware of the problem. What are the symptoms of vitamin D deficiency? Many people have no symptoms, or may complain of only vague ones such as tiredness or general aches. Because symptoms of vitamin D deficiency are often very nonspecific or vague, the problem is often missed. The diagnosis is more easily reached in severe deficiencies with some of the classical (typical) symptoms and bone deformities. Symptoms in babies and children Babies with severe vitamin D deficiency can get muscle spasms (cramps), seizures and breathing difficulties. These problems are related to consequent low levels of calcium. Children with severe deficiency may have soft skull or leg bones. Their legs may look curved (bow-legged). They may also complain of bone pains, often in the legs, and muscle pains or muscle weakness. This condition is known as rickets. Poor growth. Height is usually affected more than weight. Affected children might be reluctant to start walking.

Tooth delay. Children with vitamin D deficiency may be late teething as the development of the milk teeth has been affected. Irritability in children can be due to vitamin D deficiency. Children with vitamin D deficiency are more prone to infections. Breathing (respiratory) symptoms can occur In severe cases. Breathing can be affected because of weak chest muscles and a soft ribcage. When rickets if very severe, it can cause low levels of calcium in the blood. This can lead to muscle cramps (spasms), fits (seizures) and breathing difficulties. These need urgent hospital treatment. Rarely, an extremely low vitamin D level can cause weakness of the heart muscle (cardiomyopathy). Symptoms in adults Some people complain of a general tiredness, vague aches and pains and a general sense of not being well. In more severe deficiency (known as osteomalacia), there may be more severe pain and also weakness. Muscle weakness may cause difficulty in climbing stairs or getting up from the floor or a low chair, or can lead to the person walking with a waddling pattern. Bones can feel painful to moderate pressure (often more noticeable in the ribs or shin bones).

Not uncommonly, people have a hairline fracture in the bone which is causing tenderness and pain. Bone pain often also occurs in the lower back, hips, pelvis, thighs and feet. Read more blog posts How is vitamin D deficiency diagnosed? It may be suspected from your medical history, symptoms, or lifestyle. A simple blood test for vitamin D level can make the diagnosis. Blood tests for calcium and phosphate levels and liver function may also show changes linked to a low level of vitamin D. Sometimes, a wrist X-ray is done for a child. This can assess how severe the problem is by looking for changes in the wrist bones. What is the treatment for vitamin D deficiency? The treatment is to take vitamin D supplements. This is a form of vitamin D called ergocalciferol or calciferol . Vitamin D can be given as an injection or as a medicine (liquid or tablets). Your doctor will discuss the dose, and best treatment schedule, depending on your situation, age, severity of the deficiency, etc. Briefly, one of the following may be advised. Injection A single small injection of vitamin D will last for about six months. This is a very effective and convenient treatment.

It is useful for people who do not like taking medicines by mouth, or who are likely to forget to take their tablets. High-dose tablets or liquids There are different strengths available and a dose may be taken either daily, weekly or monthly. This will depend on your situation and on which particular treatment guideline your doctor is using. Always check with your doctor that you understand the instructions - with high doses of vitamin D it is important to take the medicine correctly. The advantage of the higher-dose treatment is that the deficiency improves quickly - important in growing children. Standard-dose tablets, powders or liquids These are taken every day for about 12 months so that the body can catch up on the missing vitamin D. This is a rather slow method of replacing vitamin D, but is suitable if the deficiency is mild, or for prevention. Maintenance therapy after deficiency has been treated Once vitamin D deficiency has been treated, the body's stores of vitamin D have been replenished. After this, maintenance treatment is often needed long-term, to prevent further deficiency in the future. This is because it is unlikely that any risk factor for vitamin D deficiency in the first place will have completely resolved. The dose needed for maintenance may be lower than that needed to treat the deficiency.

More related content Preventing vitamin D deficiency Various groups of people (detailed earlier) are prone to develop vitamin D deficiency. Therefore, certain people are advised to take vitamin D supplements routinely. In February 2012 the Chief Medical Officers for the United Kingdom issued the following recommendations: All pregnant and breast-feeding women should take a daily supplement containing 10 micrograms of vitamin D. All babies and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops. However, those babies who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D. Breast-fed babies may need to receive drops containing vitamin D from one month of age if their mother has not taken vitamin D supplements throughout pregnancy. People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10 micrograms of vitamin D. In addition a doctor may advise routine vitamin D supplements for people with certain gut, kidney or liver diseases, people prescribed certain medicines, and to certain people with darker skin. You can buy vitamin D supplements at pharmacies.

They are also available on prescription to certain groups of people. Women and children from families who are eligible for the Government’s Healthy Start scheme (see below) can also get free vitamin supplements which include vitamin D. If you are unsure as to whether you should be taking a regular supplement of vitamin D, or what the appropriate dose is, then your doctor, pharmacist, health visitor or midwife can advise. Cautions when taking vitamin D supplements Care is needed with vitamin D supplements in certain situations: If you are taking certain other medicines: digoxin (for an irregular heartbeat - atrial fibrillation) or thiazide diuretics such as bendroflumethiazide (commonly used to treat high blood pressure). In this situation, avoid high doses of vitamin D, and digoxin will need monitoring more closely. If you have other medical conditions: kidney stones, some types of kidney disease, liver disease or hormonal disease. Specialist advice may be needed. Vitamin D should not be taken by people who have high calcium levels or certain types of cancer. You may need more than the usual dose if taking certain medicines which interfere with vitamin D.

These include: carbamazepine, phenytoin, primidone, barbiturates and some medicines for the treatment of HIV infection. Multivitamins are not suitable for long-term high-dose treatment because the vitamin A they also contain can be harmful in large amounts. Are there any side-effects from vitamin D supplements? It is very unusual to get side-effects from vitamin D if taken in the prescribed dose. However, very high doses can raise calcium levels in the blood. This would cause symptoms such as thirst, passing a lot of urine, nausea or vomiting, dizziness and headaches. If you have these symptoms, you should see your GP promptly, so that your calcium level can be checked with a blood test. Some guidelines advise that people taking high vitamin D doses should have their calcium levels checked during the first few weeks. In practice, this is not usually done unless you develop symptoms of a high blood calcium level. What is the outlook (prognosis)? The outlook is usually excellent. Both the vitamin levels and the symptoms generally respond well to treatment. However, it can take time (months) for bones to recover and symptoms such as pain to get better or improve. The complications of severe deficiency have been mentioned.

Rickets can occur in children, and osteomalacia in adults. These diseases affect the strength and appearance of bones, and can lead to permanent bone deformities if untreated or if treatment is delayed. Vitamin D has been linked to other diseases. In recent years there have been associations with conditions such as cancer, heart disease, infectious disorders, autoimmune disease and diabetes. This does not mean that all people with vitamin D deficiency will get these problems. Nor does it mean that if you have one of these illnesses, a vitamin D deficiency is the cause. In these cases, vitamin D is thought to be just one factor. Follow-up Most people who are treated for vitamin D deficiency will need to be reviewed a few weeks or months after starting treatment, depending on how severe their symptoms are. A further review after one year is advised. Further help & information 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! Scripps Health - Rickets Articles Rickets X-rays are a form of ionizing radiation that can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.

Also known as: Osteomalacia in children, Vitamin D deficiency, Renal rickets or Hepatic rickets Definition Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Causes Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones. This leads to weak and soft bones. Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D production by the skin may occur in people who: Live in climates with little exposure to sunlight Must stay indoors 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. 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. See also

Question: The predominant cause of rickets is a deficiency of which vitamin?
Answer: D