Rickets

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It has been suggested that Osteomalacia be merged into this article or section. (Discuss)

**Rickets**
*Classifications and external resources*
ICD-10	E 55.
ICD-9	268
DiseasesDB	9351
MedlinePlus	000344
eMedicine	ped/2014
MeSH	D012279

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.

1 Epidemiology
2 Etiology
3 Presentation
4 Diagnosis
5 Treatment and prevention
- 5.1 Diet and sunlight
- 5.2 Supplementation
6 References
7 External links

[edit] Epidemiology

Tho 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
Individuals with red hair

[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

Image:Cholecalciferol.png Image:Ergocalciferol.png 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.