Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Yes, deficiency of vitamin D can cause bone pain and muscle weakness.
However, mild vitamin D deficiency is not necessarily associated with any
symptoms. Vitamin D has been referred to as the "sunlight vitamin" because it is
made in our skin when we are exposed to sunlight. It can also be obtained
through dietary sources, but the main source of vitamin D in our diet is foods
that have been fortified to include the vitamin (such as in milk and other dairy
products). Vitamin D is only found naturally in significant levels in a few
foods, including fatty fish, cod-liver oil, and eggs.
Vitamin D acts to regulate the calcium and phosphate levels in the body, thus
promoting healthy bones. The characteristic vitamin D deficiency state is called
rickets. Rickets causes softening and poor mineralization of the bones, leading
to skeletal deformities. While rickets is the term typically used to describe
the condition in children, osteomalacia refers to the weakening of bones seen in
adults who are severely deficient in vitamin D.
The many roles of vitamin D in maintaining health and well-being are a
subject of active and ongoing research. Even subclinical (not producing signs or
symptoms) deficiencies in vitamin D have been linked to significant health
problems. Preliminary studies have shown that in addition to weakening of the
bones, vitamin D deficiency may be associated with conditions as varied as
cancers, asthma, cardiovascular disease, and autoimmune diseases.
Rickets is a disorder caused by a deficiency of vitamin D,
calcium, or phosphate.
Rickets leads to softening and weakening of the bones and is
seen most commonly in children 6-24 months of age. There are several subtypes of
rickets, including hypophosphatemic rickets (vitamin-D-resistant rickets), kidney
rickets (renal osteodystrophy), and, most commonly, nutritional rickets (caused
by dietary deficiency of vitamin D, calcium, or phosphate). Classic nutritional
rickets is also medically termed osteomalacia.
What is the history of rickets?
Roman descriptions of individuals with rickets can be found as early as the second century, and in the 1640s, the condition was well documented as a common bone ailment across England. Unfortunately, the scientifically proven cause of rickets was not identified until the 1920s, and by the 1930s, public-health initiatives recommend fortifying milk with vitamin D and cod-liver oil as a nutritional supplement for young infants and children. This
led to a near eradication of rickets in the United States and other
industrialized nations. Unfortunately, rickets has made a comeback and is still
common in less-developed nations. Moreover, for a variety of reasons, rickets is
seen more frequently amongst infants and children living in industrialized
nations, often among more affluent populations.
What causes rickets?
Regardless of the type of rickets, the cause is always either
due to a deficiency of vitamin D, calcium, or phosphate. Three common causes of
rickets include nutritional rickets, hypophosphatemic rickets, and renal rickets.
Nutritional rickets
Nutritional rickets, also called osteomalacia, is a
condition caused by vitamin D deficiency. Vitamin D is a fat-soluble vitamin
that is essential for the normal formation of bones and teeth and necessary for
the appropriate absorption of calcium and phosphorus from the bowels. It occurs
naturally in very small quantities in some foods such as saltwater fish (salmon,
sardines, herring, and fish-liver oils). Vitamin D is also naturally synthesized
by skin cells in response to sunlight exposure. It is necessary for the
appropriate absorption of calcium from the gut.
Infants and children most at
risk for developing nutritional rickets include dark-skinned infants,
exclusively breastfed infants, and infants who are born to mothers who are
vitamin D deficient. In addition, older children who are kept out of direct sunlight or who
have vegan diets may also be at risk.
Hypophosphatemic rickets
Hypophosphatemic rickets is caused by low levels of
phosphate. The bones become painfully soft and pliable. This is caused by a
genetic dominant X-linked defect in the ability for the kidneys to control the
amount of phosphate excreted in the urine. The individual affected is able to
absorb phosphate and calcium, but the phosphate is lost in the urine. This is
not caused by a vitamin D deficiency. Patients with hypophosphatemic rickets
typically have obvious symptoms by 1 year of age. Treatment is generally
through nutritional supplements of phosphate and calcitriol (the activated form
of vitamin D).
Renal (kidney) rickets
Similar to hypophosphatemic rickets, renal rickets is
caused by a number of kidney disorders. Individuals suffering from kidney
disease often have decreased ability to regulate the amounts of electrolytes
lost in the urine. This includes calcium and phosphate, and therefore the
affected individuals develop symptoms almost identical to severe nutritional
rickets. Treatment of the underlying kidney problem and nutritional
supplementation are recommended for these patients.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Tetanus is an often-fatal disease caused by nerve toxins produced by the common bacteria Clostridium tetani. In a seven-day period after infection, a person experiences muscle spasms, restlessness, headache, irritability, then lockjaw, and the lungs stop functioning. Tetanus is treatable with antibiotics and drainage. Sedation is often give to stop muscle spasms.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Vitamins are organic substances that are essential for the proper growth and functioning of the body. Calcium is a mineral essential for healthy bones and is also important for muscle contraction, heart action, and normal blood clotting.
It's important to know whether you will breastfeed or bottle-feed your baby prior to delivery, as the breasts' ability to produce milk diminishes soon after childbirth without the stimulation of breastfeeding. Breast milk is easily digested by babies and contains infection-fighting antibodies and cholesterol, which promotes brain growth. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. This article explores the advantages and disadvantages of both forms of feeding.
GERD (gastroesophageal reflux disease) is the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Common symptoms of GERD in children include colic, feeding problems, poor growth, frequent vomiting or coughing, heartburn, regurgitation, recurrent wheezing, pneumonia, choking, or gagging. Treatment may involve elevating the child's bed, keeping the child upright after eating, limiting foods that seem to make the reflux worse, encouraging your child to exercise, and serving several small meals a day.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Renal osteodystrophy is a bone disease. The kidneys fail to maintain required levels of phosphorous and calcium in the blood. Renal osteodystrophy is common in patients with kidney disease and affects dialysis patients. Diagnosis is performed with a blood sample, and in some cases a bone biopsy. Medication is the general treatment for renal osteodystrophy.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
Symptoms of bone pain and
muscle weakness can mean you have a vitamin D deficiency. However, for many
people, the symptoms are subtle. Yet even without symptoms, too little vitamin D
can pose health risks. Low blood levels of the vitamin have been associated with
the following:
Increased risk of death from cardiovascular disease
Cognitive impairment in
older adults
Severe asthma in children
Cancer
Research suggests that vitamin D
could play a role in the prevention and treatment of a number of different
conditions, including type1 and type 2 diabetes,
hypertension, glucose
intolerance, and multiple sclerosis.
Causes of Vitamin D Deficiency
Vitamin D deficiency can occur for a number of
reasons:
You don't consume the recommended levels of the vitamin over time. This is
likely if you follow a s...
Yes, deficiency of 
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