Rickets (Calcium, Phosphate, or Vitamin D Deficiency)

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    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.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    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.

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What are rickets symptoms and signs?

Signs and symptoms of rickets include bone pain or tenderness, dental deformities, delayed formation of teeth, decreased muscle strength, impaired growth, short stature, and a number of skeletal deformities, including abnormally shaped skull (craniotabes), bowlegs, rib-cage abnormalities (rachitic rosary), and breastbone, pelvic, and spinal deformities.

Occasionally, in very severe rickets, patients may develop even more serious signs and symptoms associated with very low levels of calcium or phosphate. These might include tetany (involuntary muscle contractions) or seizures. These are medical emergencies and require immediate treatment.

How do health-care professionals diagnose rickets?

Rickets is initially diagnosed clinically with a complete medical and nutritional history and with a complete physical exam by a health professional. If rickets is suspected in a child and the child has no acute symptoms such as seizures or tetany, X-rays of long bones (radius, ulna, and femur) and ribs are obtained.

Vitamin D levels, alkaline phosphatase, parathyroid hormone (hormone involved in calcium and phosphate control), and electrolytes, including indirect measurements of kidney function (BUN and creatinine), should be evaluated if the X-rays show any of the following characteristics that are consistent with rickets:

  • Widening or abnormally shaped metaphysis (most actively growing part of the bone below the growth plate)
  • Obvious bowing of the femurs
  • Osteopenia (bones which are not as dense, a sign of decreased mineralization)
  • Rib flaring (rachitic rosary)
  • Multiple fractures at different healing stages

Different causes of rickets will reveal different findings on laboratory tests. For the scope of this article, we will focus on vitamin D deficiency. In these cases, the active form of vitamin D will be decreased, parathyroid hormone will be increased, and calcium and phosphate will be decreased.

Medically Reviewed by a Doctor on 3/7/2016
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