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Rickets

life science Maturity 7-9 Next article →

Rickets is a medical condition that results in weak or soft bones in children. It is a serious issue because it affects how a child's skeleton develops and grows. This condition can be caused by dietary deficiencies or by hereditary genetic factors. While rickets affects children, the analogous condition seen in adults is called osteomalacia. A child who appears to suffer from this condition is described as rachitic. Understanding rickets is vital because, if left untreated, the bone deformities can persist into adult life.

Skeleton Infant Rickets
Skeleton Infant Rickets

The underlying mechanism of rickets involves insufficient calcification of the growth plate. Calcification is the process where the body uses minerals to harden bone tissue. To do this effectively, the body requires sufficient levels of serum phosphate and calcium. Vitamin D plays a critical role in this process by ensuring these minerals are properly absorbed. Sunlight is a key source of this vitamin. Specifically, ultraviolet light allows human skin cells to convert vitamin D from an inactive state to an active state. Without enough vitamin D, the body cannot absorb dietary calcium properly, leading to hypocalcaemia, or low calcium in the blood.

Cholecalciferol
Cholecalciferol

Symptoms of rickets can manifest in many different ways across the body. Early signs in infants may include craniotabes, which are soft and thinned skull bones. Other skeletal changes include skull bossing or a delayed closure of the fontanelles. As children grow, they may develop bowed legs or knock knees. The spine may also experience curvatures known as kyphoscoliosis or lumbar lordosis. Some children develop a condition called rachitic rosary. This creates visible bumps on the costochondral joints that look like a string of beads. Advanced cases may show a "square-headed" appearance called caput quadratum or a deformed chest known as Harrison's groove.

Rickets wrist
Rickets wrist
RicketsChestXray
RicketsChestXray

Diagnosis typically relies on a combination of blood tests and medical imaging. Doctors look for specific chemical markers in the blood, such as low calcium, low phosphorus, and high alkaline phosphatase. X-rays, or radiographs, are used to see the physical structure of the bones. In an advanced patient, an X-ray might show the outward curve of the long bones in the legs. It can also reveal the widening, cupping, or fraying of the metaphyses. These changes are most common at sites of rapid growth, such as the distal radius in the wrist or the proximal humerus in the arm.

RicketsXray
RicketsXray
RicketsXray
RicketsXray

History shows that rickets has been a human health challenge for centuries. Descriptions of the disease date back to the 1st century AD and were widespread in the Roman Empire. During the Industrial Revolution, rickets became a major problem in cities like London. Thick fog and heavy industrial smog blocked the sunlight needed for vitamin D production. In the 19th century, autopsy studies in Boston and Leiden found that 80% to 90% of children had some degree of rickets. Because of its prevalence in England, it was sometimes referred to as "the English Disease" in other languages.

Risk factors for rickets vary based on diet, environment, and biology. Exclusive breastfeeding without vitamin D supplementation is a significant risk for infants. People with darker skin require more sunlight to maintain vitamin D levels, which can increase risk in certain environments. Additionally, cultural practices involving long garments or veils can act as sunlight barriers. In the Middle East, despite high sun exposure, rickets rates remain high due to limited sun exposure from cultural practices and low dietary calcium. In the United States, vitamin D insufficiency varies by ethnicity; for example, among females over 70, the rate is 28.5% for non-Hispanic whites but 68% for non-Hispanic blacks.

Prevention and treatment focus on correcting the underlying cause of the deficiency. For dietary rickets, treatment usually involves vitamin D and calcium supplements, which can show improvements within a few weeks. Prevention for breast-fed infants includes vitamin D supplements or increased sunlight exposure. Many foods provide vitamin D, such as eggs, butter, margarine, and fortified milk. Oily fishes like salmon, tuna, and herring are also excellent sources. In some cases, surgery may be required to correct permanent bone deformities. Genetic forms of the disease are more complex and typically require specialized medical treatment.

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🖼️ Images & Media (6)
File:Rickets wrist.jpg
Rickets wrist.jpg
File:RicketsXray.jpg
RicketsXray.jpg
File:RicketsChestXray.jpg
RicketsChestXray.jpg
File:Cholecalciferol.svg
Cholecalciferol.svg
File:Ergocalciferol.svg
Ergocalciferol.svg
File:Skeleton Infant Rickets.jpeg
Skeleton Infant Rickets.jpeg
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