Rickets

From Encyclopedia Jr, free information reference for Kids

Osteomalacia, also known as rickets, is among the most frequent childhood diseases in developing countries. The predominant cause is a vitamin D deficiency, but lack of adequate calcium in the diet may also lead to rickets. Although it can occur in adults, the majority of cases occur in children suffering from severe malnutrition, usually resulting from famine or starvation during the early stages of childhood.

[edit] Epidemiology

Those at higher risk for developing rickets include:

• Dark-skinned individuals
• Breast-fed infants whose mothers are not exposed to sunlight
• Breast-fed infants who are not exposed to sunlight
• Individuals on vegetarian or vegan diets who do not drink milk
• Lactose intolerant individuals
• Red Heads (Gingers)

[edit] Etiology

Vitamin D is required for proper calcium absorption from the gut. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in hypocalcemia, leading to skeletal and dental deformities and neuromuscular symptoms, e.g. hyperexcitability.

[edit] Presentation

Signs and symptoms of rickets include:

• Bone pain or tenderness
• dental problems
• muscle loss
• increased tendency for fractures (easily broken bones)
• Skeletal deformity
  • Bowed legs
  • Cranial, spinal, and pelvic deformities
• Growth disturbance
• Hypocalcaemia (low level of calcium in the blood), and
• Tetany (uncontrolled muscle spasms all over the body).

The X-ray, or radiograph, in the article is the classic image of advanced rickets sufferers: bow legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life if not treated.

[edit] Diagnosis

A doctor may diagnose rickets by:

• Blood tests to measure calcium and phosphorus levels
• X-rays of affected bones

[edit] Treatment and prevention

[edit] Diet and sunlight

Cholecalciferol (D3)

Ergocalciferol (D2)

Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet in sunshine, cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D.

A sufficient amount of ultraviolet in sunlight each day and adequate supplies of calcium and phosphorous in the diet can prevent rickets. Darker-skinned babies need to be exposed longer to the ultraviolet rays. The replacement of vitamin D has been proven to correct rickets using these methods of ultraviolet light therapyand medicine.

Recommendations are for 200 international units (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance.

[edit] Supplementation

Sufficient vitamin D levels can also be achieved through dietary supplementation. Vitamin D3 (cholecalciferol) is the preferred form since it is more readily absorbed than vitamin D2. Most dermatologists recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of skin cancer associated with sun exposure.

According to the American Academy of Pediatrics (AAP), infants who are breast-fed may not get enough vitamin D from breast milk alone. For this reason, the AAP recommends that infants who are exclusively breast-fed receive daily supplements of vitamin D from age 2 months until they start drinking at least 17 ounces of vitamin D-fortified milk or formula a day.

[edit] References

[edit] External links

• Dr. Susan Ott's website on osteomalacia
• Rickets - Symptoms, Causes, Treatment
• Dictionary.com - Osteomalacia
• Fluoride & Osteomalacia
• History of Vitamin D and the battle against Rickets
• Chorus 00906