Rickets is a disease condition of the bone that affects growing children. It causes bone fragility in children resulting in deformities. The disease is described by weak, soft bones, stunted skeletal development evidenced by short stature and bow legs. In the past, it was a common disorder that is linked to poor nutrition and reduced exposure to ultraviolet rays or light from the sun. Later, scientific investigation found that calcium, phosphorus, and vitamin D play an important role in bone formation. The the early 1900s, Europe had a high percentage of Rickets, which resulted in what was described as an epidemic. Further research on the physiological role of vitamin D increased the understanding of its role in Rickets disease. Calcium and phosphorus-containing products such as milk and cod-liver oils helped in controlling and eliminating Rickets in most parts of the world. Today, cultural beliefs and dietary lifestyles of regions and communities still have vestiges of Rickets prevalence (Joiner, Foster, & Shope, 2000). Socioeconomic status of parents can also contribute to the Rickets disease prevalence because of their inability to access calcium and phosphorus-rich meals.
The causes of Rickets disease are nutritional deficiency and lack of exposure to sunlight (Wharton &Bishop, 2003). The body utilizes sunlight to convert cholesterol molecules to vitamin D which the body needs for bone mineralization. Dark skin, lack of sunlight, results in Rickets. A substantial amount of vitamin D is formed in the body. Some quantity is formed through diets. The presence of vitamin D triggers a biochemical process that converts the vitamin into a hormone called 1,25-diOH-D (Holick, 2002). This hormone is what is responsible for the absorption of calcium in the gastrointestinal tract to the bones. A defect in this pathway is the main cause of Rickets. Thus, Rickets is caused by a deficiency of calcium in the body and this deficiency is due to low cholesterol, absence of light, and vitamin D. A genetic cause of Rickets has also been identified by the inability of the kidney to maintain optimum phosphate levels.
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Fundamentally, the symptoms of Rickets are in the musculoskeletal system. The upper and lower limbs are mostly affected. Young children are observed to be fussy with soft skulls, delay in walking and growing, bone pain, and improper bone and joint alignment are characteristic features. Wide bones and joints, breastbones and ribs are of significant odd shapes. Large foreheads and extended abdomen are common symptoms of Rickets. Hematological examination will reveal low levels of calcium. The diagnosis of Rickets is both physical and laboratory examinations. Biochemical analysis of serum calcium, alkaline phosphate and X-ray samples can confirm a diagnosis.
The treatment of Rickets follows a diagnosis to know the underlying cause. Standard treatment options are focused on correcting the cause of decalcification or demineralization of bones. Nutritional deficiencies are corrected with food that are rich in calcium, vitamin D and phosphorus. Liver, milk, and fishy meals are nutritional recommendations in Rickets treatment. Also, children are exposed to sunlight if the cause is the absence of sunlight. In severe cases, bracing a child’s bones and surgery are rare options. Treatment offered early can restore deformities before a child gets into adolescence. Rickets in children is now preventable because of available information (Hartmann, 2000). Prevention can be achieved by breastfeeding or getting commercially available infant formulas fortified with vitamin D. Children are also exposed to sunlight so that they get access to ultraviolet rays. In some countries across the world, vitamin D supplements are now mandatory for growing children.
Rickets disease is a bone condition that affects growing children. It is characterized by weak and soft bones that may be painful. The skeletal system is deformed because of the absence of sunlight, calcium, phosphorus, and vitamin D. It is treatable and preventable.
References
Hartman, J.J. (2000). Vitamin D deficiency rickets in children: prevalence and need for community education. Orthopaedic Nursing 19 , 63–67.
Holick, M.F. (2002). Vitamin D: The underappreciated D-lightful hormone that is important for skeletal and cellular health. Current Opinion in Endocrinology and Diabetes 9 , 87–98.
Joiner, T. A., Foster, C., & Shope, T. (2000). The many faces of vitamin D deficiency rickets. Pediatrics in Review, 21 (9), 296-302.
Wharton, B. & Bishop, N. (2003). "Rickets." The Lancet 362 , DOI: http://dx.doi.org/10.1016/S0140-6736(03)14636-3.
