Rickets and Osteomalacia
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Rickets and Osteomalacia

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Definition

Rickets (in children) and osteomalacia (in adults) are two forms of a metabolic bone disease resulting from vitamin D deficiency. Both cause softening and weakening of bones because of defective or inadequate bone mineralization.

Rickets

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Causes

Rickets and osteomalacia result when there is a vitamin D deficiency in the body. This may occur when:

  • The supply of vitamin D from the diet or sun exposure is inadequate.
  • The metabolism of vitamin D is abnormal.
  • Tissue is resistant to the action of vitamin D.

Vitamin D regulates calcium absorption in the body. It also controls levels of calcium and phosphate in bone. Vitamin D is absorbed in the intestines from food. Vitamin D is also produced by the skin during exposure to sunlight.

Most often, rickets and osteomalacia are caused by a deficiency of vitamin D. This can result from:

  • Insufficient vitamin D in the diet. In children, this may be related to:
    • Insufficient consumption of vitamin D-fortified milk
    • Insufficient intake of vitamin D supplements to children being breastfed or to children who are lactose intolerant
  • Lack of exposure to sunlight.

Less often, rickets and osteomalacia can be caused by other disorders that affect vitamin D absorption, metabolism, or action in the body such as:

  • Kidney problems:
    • A hereditary disorder of the kidney called vitamin D-resistant rickets
    • Renal tubular acidosis—a nonhereditary kidney disorder which causes bone calcium to dissolve
    • Chronic kidney failure
    • Long-term kidney dialysis
  • Diseases of the small intestines with malabsorption
  • Disorders of the liver or pancreas disease
  • Cancer
  • Certain drugs, such as:
    • Certain seizure medications, such as phenytoin or phenobarbital
    • Acetazolamide
    • Ammonium chloride
    • Disodium etidronate
    • Fluoride treatment
  • Toxicity or poisoning from:
    • Cadmium
    • Lead
    • Aluminum
    • Outdated tetracycline

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for rickets/osteomalacia include:

  • Age in children: 6 to 24 months old
    • Either the child is consuming breast milk (from a mother who is deficient in vitamin D) or milk not fortified with vitamin D.
  • Age in adults: 50-80 years
  • Lactose intolerance with inadequate intake of vitamin D-fortified milk
  • Family history of rickets
  • Race: Black, especially in association with breastfeeding

Symptoms

Symptoms may include:

  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Bow legs or knock knees
  • Deformity or curvature of the spine
  • Pigeon chest (forward protrusion of the chest bone)
  • Impaired growth, resulting in short stature
  • Susceptibility to bone fractures
  • Dental deformities
  • Delayed tooth formation
  • Defects in teeth
  • Increased cavities
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Poor muscle development and tone
  • Muscle weakness
  • Delay of learning to walk in children

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests to confirm the diagnosis may include:

  • Blood and urine tests
  • Bone x-rays
  • Bone biopsy , when other tests are not conclusive

Treatment

Treatment attempts to:

  • Correct the underlying cause
  • Relieve or reverse symptoms

Treating the Underlying Cause

Treatment of the underlying cause may include:

  • Adding the following to your diet:
    • Vitamin D-fortified dairy products
    • Foods high in vitamin D (such as fatty fish, egg yolk, and green vegetables)
    • Supplements of vitamin D, calcium, and other minerals
    • Biologically active vitamin D
  • Adequate but not excessive exposure to sunlight

Treating Symptoms

Treatment to relieve or correct symptoms may include:

  • Wearing braces to reduce or prevent bony deformities
  • In severe cases, surgery to correct bony deformities

Prevention

To help prevent rickets or osteomalacia:

  • Drink vitamin D-fortified milk.
  • Consume sufficient vitamin D, calcium, and other minerals. If you think your diet may be deficient, talk with your doctor about alternate sources of vitamins and minerals.
  • Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually considered sufficient. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants or children. Children with dark skin and their mothers are at increased risk for rickets and may need more sun exposure and dietary supplementation with vitamin D.
  • Breastfed, dark-skinned babies should receive 400 International Units per day (IU/d) of supplementation with vitamin D starting at no later than two months of age.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

American Dietetic Association
http://www.eatright.org

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Alberta Children's Services
http://www.child.alberta.ca/home/

References:

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .

The Merck Manual of Medical Information—Home Edition . Simon and Schuster, Inc; 2000.

US National Library of Medicine website. Available at: http://www.nlm.nih.gov/ .



Last reviewed December 2007 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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