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 is the treatment for rickets?

The treatment for rickets depends upon the cause as mentioned above in the discussion of hypophosphatemic rickets and renal rickets. In cases of nutritional rickets and vitamin D deficiency, treatment is simple. The first step is to prevent the complications of calcium and phosphate deficiency by correcting any abnormal levels with supplemental calcium or phosphate as well as the activated vitamin D (calcitriol). Once the diagnosis of rickets is confirmed, initiation of vitamin D supplementation is recommended, as well as a diet rich in calcium. This is especially important for children on vegan diets. The treatment for some of the bony abnormalities depends on the severity of the cases and may require referral to an orthopedic provider for evaluation.

Who are the specialists who treat rickets?

Pediatricians and family practitioners usually care for children with nutritional rickets without consulting specialists. Kidney specialists (nephrologists) generally help manage renal rickets as well as hypophosphatemic rickets and sometimes a pediatric endocrinologist (specializes in hormones) may get involved.

What is the prognosis for rickets?

Outcomes for children with nutritional rickets are excellent, especially if diagnosed early. Appropriate supplementation with calcium and vitamin D will lead to healing of the bony defects within days to months. Severe bowing, seen in longer-standing cases of rickets, may also resolve over a number years without requiring surgical intervention. In patients with very advanced disease, however, the bony changes may be permanent.

Is it possible to prevent rickets?

Pediatricians, family practitioners, and obstetricians are responsible for educating parents (and expecting parents) about measures to prevent rickets. For the expecting mother, this includes recommending prenatal vitamins and appropriate nutritional counseling. For the new mother, it is important for her to be advised about vitamin D supplementation for exclusively breastfed babies and, as the child gets older and begins to wean, appropriate nutritional counseling, and reasonable sun exposure for the child.

Vitamin D insufficiency is increasingly being recognized as an under-detected health risk for people of all ages in the United States. Up to 30% of U.S. children are vitamin D deficient to some degree and worldwide this is a much higher percentage. In 2011, the American Academy of Pediatrics (AAP) published a technical report titled "UV Radiation: A Hazard to Children and Adolescents" that concluded that all "infants, children, and adolescents receive vitamin D supplementation and avoid overexposure to sunlight and artificial sources due to the health risks (cancer, etc)." Currently, studies are unclear about how much vitamin D is enough in certain populations, but the current recommendation is for at least 400 IU daily.

Given the fact that vitamin D supplementation may not be readily available worldwide, more research needs to be performed to determine the "safe" amount of sunlight exposure for infants and children if we are going to successfully prevent rickets throughout the world.

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCES:

Balk, S.J. "UV Radiation: A Hazard to Children and Adolescents." Pediatrics 127.3 Mar. 2011: e791-e817.

Holick, M.F. "Vitamin D Deficiency; Review Article-Medical Progress." N Engl J Med 357 (2007): 266-281.

Holick, M.F. and T.C. Chen. "Vitamin D Deficiency: A Worldwide Problem With Health Consequences." Am J Clin Nutr 87 (2008): 1080S-1086S.

Joiner, T., et al. "The Many Faces of Vitamin D Deficiency Rickets." Pediatrics in Review 21 (2000): 296.

Misra, M., et al. "Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations." Pediatrics 122.2 Aug. 2008: 398-417.

Mughal, M.Z. "Rickets." Current Osteoporosis Report. 9.4 Dec. 2011: 291-299.

Rajakumar, Kumaravel. "Vitamin D, Cod-Liver Oil, Sunlight, and Rickets: A Historical Perspective." Pediatrics 112.2 Aug. 2003, e132-e135. <http://www.pediatrics.org/cgi/content/full/112/2/e132>.

Wagner, C., and F. Greer. "Prevention of Rickets and Vitamin D deficiency in Infants, Children and Adolescents." Pediatrics 122 Nov. 2008: 1142-1152.

Medically Reviewed by a Doctor on 3/7/2016

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