Rickets

Rickets is deficient mineralisation at the growth plate of long bones, resulting in faltering growth. If the underlying condition is not treated, bone deformity occurs, typically causing bowed legs and thickening of the ends of long bones.

Rickets only occurs in growing children before fusion of the epiphyses, and typically affects the wrists, knees, and costochondral junctions.

Rickets occurs primarily as a result of a nutritional deficiency of vitamin D, but can be associated with nutritional deficiencies of calcium or phosphorus. Hypophosphataemic rickets is a common genetic cause of rickets.

The mainstay of treatment is to correct vitamin D deficiency and to ensure adequate calcium intake.

Vitamin D deficient rickets can be prevented in many cases by ensuring that children and pregnant women have sufficient vitamin D and calcium intake.

Rickets refers to changes caused by deficient mineralisation at the growth plate of long bones. Osteomalacia refers to impaired mineralisation of the bone matrix. Rickets and osteomalacia usually occur together while the growth plates are open. Rickets only occurs in growing children before fusion of the epiphyses; osteomalacia can occur after the growth plates have fused.[1]Pettifor JM. Rickets and vitamin D deficiency in children and adolescents. Endocrinol Metab Clin North Am. 2005 Sep;34(3):537-53, vii. http://www.ncbi.nlm.nih.gov/pubmed/16085158?tool=bestpractice.com [2]Pitt MJ. Rickets and osteomalacia are still around. Radiol Clin North Am. 1991 Jan;29(1):97-118. http://www.ncbi.nlm.nih.gov/pubmed/1985332?tool=bestpractice.com

Rickets can manifest in childhood at the distal forearm, knee, and costochondral joints, as these are sites of rapid bone growth, where large quantities of calcium and phosphorus are required for mineralisation.[3]Elder CJ, Bishop NJ. Rickets. Lancet. 2014 May 10;383(9929):1665-76. http://www.ncbi.nlm.nih.gov/pubmed/24412049?tool=bestpractice.com ​ Characteristic features include widening of the bones at the wrists and knees, bowing of the legs, spine deformities, fractures, bone pain, and dental abnormalities.[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26. https://www.aafp.org/afp/2006/0815/p619.html http://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com