10 Things You Should Know About Rickets
By Dan Mullen
Because bones are essential for movement and maintaining the body’s structure, it is important that people maintain a diet and lifestyle that keeps their bones strong. This is especially crucial for children because their bones are still growing. When children do not acquire the proper nutrients to build strong bones, Rickets—a disease marked by weak, soft bones—can develop. This list of 10 things you should know about Rickets will equip you with information about the disease and help you ensure proper bone health in your children:
1. Rickets is caused by a deficiency of Vitamin D3 (a.k.a. cholecalciferol). This vitamin is an essential nutrient for bone health and can be obtained through limited exposure to sunlight and the consumption of dairy products.
2. The body uses Vitamin D3 to synthesize calcitriol: a hormone that helps the small intestine absorb calcium and phosphorus. Bones act as a storage reserve for calcium that is not needed as long as levels of calcium ions in the blood are normal. However, when those levels fall below normal, parathyroid hormone is released, which stimulates bones’ osteoclast cells to release the minerals stored in bones. If calcium is removed from bones faster than it can be re-deposited, the bones weaken, becoming more susceptible to physical damage and deformities (6).
3. The most common sign of Rickets is bowed legs, which develop when bones in an affected child’s legs can no longer support the forces exerted by their body weight. The legs bend laterally (or ‘bow’) as a result. (6).
4. Aside from bowed legs, other signs and symptoms of Rickets include stunted growth, spinal pain and curvature, pelvis and leg pain, muscle weakness, problems with tooth development, wider-than-normal joints at the elbows, wrists and ankles, malformed ribs, and a larger-than-normal forehead and/or abdomen (3).
5. According to the Mayo Foundation for Medical Education and Research, breast-fed infants must receive supplemental Vitamin D3 because breast milk alone doesn’t contain enough D3 to build/maintain proper bone mass and prevent Rickets. The American Academy of Pediatrics recommends that breast-fed babies be given liquid Vitamin D drops every day to compensate for this deficiency. The drops can be purchased from major retailers including Walgreens, CVS Pharmacy and Amazon.com (7) (8).
6. The United States and parts of Europe experienced a Rickets epidemic toward the end of the 19th Century. This was partially due to the effects of the Industrial Revolution on the atmosphere. As modern factories were built in cities, the pollutants released by those factories blocked a certain amount of sunlight. The United States fought and beat the epidemic by fortifying its milk with Vitamin D (1) (2).
7. According to Juhi Kumar, MD, MPH; and Michal Melamed, MD; authors and conductors of a 2009 study on the prevalence of Vitamin D deficiency in American children, approximately 10 percent of American children are Vitamin D deficient. The percentage of American kids who generally don’t get enough Vitamin D (regardless of whether or not they actually have a deficiency) is about 70%. Insufficient amounts of Vitamin D might have been a reason why reported cases of Rickets were increasing when the study was published (2).
8. Some doctors believe that paranoia about sun exposure might be leading to increases in Vitamin D deficiency in children (and related problems such as Rickets). This is because the sunscreen parents tell their children to rub on during warm weather can actually inhibit Vitamin D production in the body. Limited daily exposure to sunlight without the use of sunscreen—meaning 5-15 minutes—is usually enough for a child’s body to make sufficient levels of Vitamin D (5) (9).
9. A child’s skin tone and weight can affect their chances of getting Rickets because of possible Vitamin D deficiencies. The pigment melanin, which is found in higher concentrations in people with darker-colored skin, lessens a person’s ability to produce Vitamin D with sunlight. Overweight and obese children are also more likely to have Vitamin D deficiencies because excess adipose tissue takes more Vitamin D out of the blood (9).
10. There is a hereditary form of Rickets, which can become evident when a child’s kidneys cannot absorb the mineral phosphate well enough to get a sufficient amount of it into the bloodstream. Phosphate, like calcium, is crucial to the formation and strength of bones. Treatments for this form of Rickets often involve monitoring and increasing levels of calcium and phosphorus in the blood (4).
1. Conis, Elena. Fortified Foods Took Out Rickets. 24 July 2006. Los Angeles Times. 21 March 2011. http://articles.latimes.com/2006/jul/24/health/he-esoterica24.
2. DeNoon, Daniel J. 7 in 10 U.S. Kids Have Low Vitamin D. 3 August 2009. WebMD, LLC. 22 March 2011. http://children.webmd.com/news/20090803/7-in-10-kids-have-low-vitamin-d.
3. Familydoctor.org Editorial Staff. Rickets: What It Is and How It’s Treated. Updated November 2010. American Academy of Family Physicians. 21 March 2011. http://familydoctor.org/online/famdocen/home/children/parents/special/bone/902.printerview.html.
4. Genetics Home Reference. Hereditary Hypophosphatemic Rickets. 20 March 2011. U.S. National Library of Medicine. 23 March 2011. http://ghr.nlm.nih.gov/condition/hereditary-hypophosphatemic-rickets.
5. Healthwise. Vitamin D: Getting Enough – Topic Overview. Updated 3 April 2009. Healthwise, Incorporated. 21 March 2011. http://www.webmd.com/food-recipes/tc/getting-enough-vitamin-d-topic-overview?page=2.
6. Martini, Frederic H., & Nath, Judi L. Fundamentals of Anatomy & Physiology. 8th ed. San Francisco, CA: Pearson Benjamin Cummings, 2009. p. 165, 190, 203-204. Print.
7. Mayo Clinic Staff. Rickets: Prevention. 14 October 2010. Mayo Foundation for Medical Education and Research. 22 March 2011. http://www.mayoclinic.com/health/rickets/DS00813/DSECTION=prevention.
8. Mayo Clinic Staff. Rickets: Risk Factors. 14 October 2010. Mayo Foundation for Medical Education and Research. 22 March 2011. http://www.mayoclinic.com/health/rickets/DS00813/DSECTION=risk-factors.
9. Vogin, Gary D. Vitamin D Deficiency. 13 July 2009. WebMD, LLC. 21 March 2011. http://www.webmd.com/diet/vitamin-d-deficiency.