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Rickets: Causes, Symptoms, Treatment, and Cost

Last Updated: Jul 07, 2023

What is rickets?

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Rickets is a rare disease (or medical condition) that mainly affects children, making their bones soft and malleable. This makes it more likely for bones to break or not form correctly. In other words, rickets is a condition that causes the weakening and softening of bones in kids, usually as a result of insufficient vitamin D levels in their bodies.

Vitamin D aids your child's body in absorbing calcium and phosphorus from their everyday diet. Not getting enough vitamin D can lead to conditions like rickets, which is when the bones of your child don't have enough calcium and phosphorus.

Vitamin D or calcium supplements are usually enough to correct or treat bone-related issues associated with conditions like rickets. Having said that, if rickets is caused by another medical problem, your child may need other, more effective treatments, such as medication or surgery. It's also important to note that some skeletal deformities caused by rickets may require corrective surgeries.

Phosphorus is basically a mineral that is essential for bone strength. Rare inherited disorders that cause low levels of phosphorus in the body may require other medications and surgical procedures.

What does 'rickets' look like?

Rickets is a disease that interferes with the body's ability to use vitamin D and calcium, leading to softening of the bones. Signs and symptoms of rickets include swollen wrists and ankles, muscle weakness, bone and joint pain, and growth problems.

Rickets is more common in developing countries, where people do not get adequate sunlight exposure. Having said that, this rare condition can also affect people (mostly kids) in the developed world if they don't get enough sun exposure or if they take medications that tend to reduce their vitamin D levels.

Where is rickets most common?

  • Rickets is common in children who don't get the amount of sunlight that's usually required by their bodies. In fact, children who have parents of Asian, Middle Eastern, or African-Caribbean descent are more likely to get rickets because their darker skin requires more sunlight to absorb adequate amounts of vitamin D.
  • Also, premature babies that are born before 37 weeks have a greater chance of developing health problems later in life, such as rickets. The World Health Organization (WHO) has confirmed that rickets is making a comeback and is now a more common (or widespread) problem in parts of the world where there is less sunlight.
  • Medical experts recommend that children between the ages of one and four spend at least one hour outside each day to soak up some vitamin D from the sun. This is especially important for young children because they are more susceptible to developing a vitamin D deficiency or medical conditions like rickets.
  • Vitamin D is essential not only for growing strong bones but also for keeping the immune system healthy. Therefore, it's important that young children get enough of it. Spending time outside in the sun is one of the best ways to get vitamin D, so make sure your little ones get some sun every day!

Is rickets permanent?

No. Even though rickets is a very rare medical condition, it is usually not permanent. Most cases of rickets (especially nutritional rickets) can be treated and cured when doctors or healthcare professionals are able to catch them early.In most cases, changes to the diet, added vitamin supplements, and more sunlight exposure are enough to cure this disease. However, in some cases, other treatment options, such as surgery or medication, are required.


What's the difference between rickets and scurvy?

Scurvy is predominantly caused by a deficiency of vitamin C, which is owing to a lack of fresh fruit and vegetables in a person's diet, whereas rickets, as mentioned above, is caused by a deficiency of vitamin D. Furthermore, it must be noted that this (vitamin D) deficiency causes rickets in children and a similar condition known as osteomalacia (or softening of the bones) in adults

How many types of rickets are there?

Rickets can be classified into two major groups: phosphopenic and calcipenic. Phosphopenic or hypophosphatemic rickets usually result from increased renal excretion of phosphate, while calcipenic rickets happen primarily because of a lack of calcium in a person's body. Calcium deficiency most commonly stems from the defective functioning or low availability of vitamin D.

Hypophosphatemic rickets can be classified into three further categories: X-linked dominant hypophosphatemic rickets (the most common type), autosomal dominant hypophosphatemic rickets, and autosomal recessive hypophosphatemic rickets.

X-linked hypophosphatemic rickets is said to be the most common form of the disease, affecting approximately 1 in every 20,000 newborns around the world. This inherited disorder prevents the body from properly absorbing phosphorus, which is essential for strong and healthy bones. Hereditary hypophosphatemic rickets is usually passed down from generation to generation within families, with every other form of the condition having been identified in only a handful of families.

Summary: Rickets is a nutritional disorder found in children. It is mainly caused by a deficiency or malfunction of vitamin D, phosphorus, or calcium in a person's body. This creates disturbances in the normal growth and development of bones. This rare condition can be classified into two major groups, namely phosphopenic and calcipenic.

What are the signs and symptoms of rickets?

Rickets is a disease that is due to a deficiency and improper absorption of vitamin D, calcium, and phosphorus. Rickets can result in delayed growth or the body not reaching its full height.If a person has rickets, they may have symptoms in the spine, legs, pelvis, and arms. The muscles may feel weak. There may be an increased risk of fractures.

Some other rickets symptoms to be aware of may include delayed growth, pain and stiffness in the spine, pelvis, and legs, delayed development of motor skills, and muscle weakness. If you notice any of these potential warning signs, it's important to bring them up with a doctor so that they can properly diagnose and treat the condition.

Rickets is a serious problem for growing children as it softens the areas of tissue at the ends of their bones (growth plates). This can lead to problems with their bones not developing properly or even deformities, which may include skeletal deformities like breastbone projection, thickened ankles or wrists, knock knees, or bowed legs.

Summary: Rickets is a softening and weakening of the bones, which can lead to deformities, curvature of the spine, and other skeletal problems. This extremely rare medical condition causes a loss of calcium, and the body slows or stops production of the hormone Vitamin D, which is needed to absorb calcium. If your child experiences bone pain, muscle weakness, or visible skeletal deformities, it is important to talk to your doctor as soon as possible.

What are the causes of rickets?

Vitamin D is essential for children in order to help them absorb calcium and phosphorus from their food. Rickets can form if there is a lack of vitamin D or if the body is having difficulty processing and using it correctly. A lack of calcium, vitamin D, or both can be the cause of rickets in the majority of cases.Children can develop a vitamin D deficiency if they don't get enough from these two sources:

  • Food: Fish oil, fatty fish such as salmon and mackerel, and egg yolks are all excellent sources of vitamin D. You can also find this essential nutrient in fortified foods and beverages, such as cereal, milk, and some fruit juices. So, if you are not giving enough of these vitamin D sources to your child in their diet, you are putting them at a higher risk of developing a condition like rickets.
  • Sunlight: Adequate vitamin D production in children only occurs when their skin is exposed to sunlight. However, young ones who live in developed countries are more likely to spend a very limited amount of time outdoors and mostly use sunscreen when they are out in the sun, which blocks the sun's rays and can further be an obstruction to the skin's production of vitamin D.

Some other risk factors for developing rickets may include:

  • Dark skin or complexion
  • Child of a woman who might have experienced a vitamin D deficiency while she was pregnant
  • Premature birth
  • Kids who are exclusively breastfed (as mother's milk does not contain enough vitamin D)
  • Certain medications (in rare cases)

Summary: If a child has a diet or lifestyle that does not provide enough vitamin D, or if the body is having difficulty processing and using it correctly, the child could develop rickets. Rickets can form if there is a lack of vitamin D or if the body is having difficulty processing and using it correctly.

How can you prevent rickets?

  • To avoid developing rickets, it is important for your child to consume a diet with vitamin D and calcium, get some sun exposure, and, if needed, take vitamin D supplements. Sun exposure is the best way to get vitamin D, but during certain times of the year or in certain locations, it might not be possible to get enough exposure to sunlight.
  • For example, if your child has dark skin, it's winter, or you live in a northern latitude, they might not get enough vitamin D from sunlight. In such cases, you might need to give your child a supplement or make them eat foods that are high in vitamin D.
  • Also, owing to the risk of skin cancer, infants and young children are advised to avoid direct sun exposure or always wear sunscreen and protective clothing. This is another reason that their bodies don't get the required amount of sunlight (or vitamin D). So in order to avoid developing rickets, it is essential to ensure your child consumes foods that contain vitamin D. This can be found naturally in fatty fish such as salmon and tuna, fish oil, and egg yolks.
  • There are also food items that you can incorporate into your child's diet that have been fortified with vitamin D. These include, but are not limited to, infant formula, bread, cereal, milk, orange juice, etc.
  • Make sure to check the labels on food items to determine if they have been fortified with vitamin D. If you are pregnant, it is important to ask your doctor about taking vitamin D supplements to ensure that you and your baby are getting enough of this essential nutrient.

Summary: All infants need 400 IU of vitamin D per day, according to medical guidelines. That said, human milk only has a small amount of vitamin D, so infants who are exclusively breastfed need a supplement of the essential vitamin. In fact, there are even bottle-fed infants who may also need supplements if they are not getting enough vitamin D from their formula.

How is rickets diagnosed?

Rickets is clinically diagnosed based on the occurrence of bowed legs, muscle weakness, poor growth, and a softening of the bones. Known triggers of rickets include a lack of vitamin D, inadequate calcium intake in the diet, insufficient sunlight exposure, and/or a restrictive diet. Vitamin D deficiency is widely believed (by medical professionals and experts) to be the leading cause of rickets and a number of similar medical conditions.

As we already know, vitamin D is essential for proper calcium absorption in the body, and a deficiency of vitamin D hinders the ability to utilize calcium. So, a vitamin D test is often done as part of a screening. However, an x-ray of bone structure helps in the accurate diagnosis of rickets.

In other words, rickets is diagnosed by physical examination and X-rays. A medical professional or doctor should be able to diagnose this using a physical examination and X-rays. The x-rays will reveal bone deformities and bone softening.The doctor may also try to closely hear a 'cracking' sound when your child’s bones are bent during the physical examination. Apart from that, a blood test will be conducted to determine the level of calcium in the blood and to rule out other conditions that can cause bone deformities.

Summary: Rickets is diagnosed by physical examination, family history, and/or blood tests. A physical examination is the primary method of diagnosing rickets. A doctor can look for signs of rickets, such as a bowed leg, soft bones, and a swollen belly, by doing a physical examination.

What are the possible complications of rickets?

Rickets results from a lack of vitamin D. Vitamin D helps your body absorb calcium, so without it, bones don't form properly. Without the adequate levels of vitamin D in your body, you can't make collagen, a protein that helps make connective tissue.

Without connective tissue, your bones don't harden, so they don't grow straight. Instead, they bend and bow. This can lead to pain or deformity in the legs and spine.The most common complication of rickets is weak and soft bones in children who have not reached their full growth. These bones can easily break or deform.

All in all, rickets is a serious condition that, if left untreated, can lead to:

  • An abnormally curved spine
  • Seizures
  • Failure to grow
  • Dental defects
  • Bone deformities

Summary: Rickets refers to a condition in which there is an insufficient supply of various minerals (like calcium, phosphorus, and vitamin D) in the body. Since the body needs a healthy amount of minerals to develop and maintain strong bones, rickets is predominantly deemed a bone issue.

Home remedies for rickets

  • Rickets is a disease of childhood: It is a softening and weakening of the bones caused by a deficiency of vitamin D and calcium in the body. Moreover, the following are a few time-honored and effective natural (home) remedies for rickets:
  • Vitamin D: Vitamin D essentially aids in the absorption of essential minerals such as phosphate and calcium in our bodies, which further helps form strong bones. Serious medical conditions like rickets can stem from a vitamin D deficiency in your kids. So, if you want to prevent your child from developing such conditions, try to incorporate food items or products into your child's diet that have been fortified with vitamin D, such as infant formula, bread, cereal, milk, orange juice, etc.
  • Sunlight: Sunlight stimulates the body to produce Vitamin D. To keep children's bones strong, make them play outside for at least an hour every day.
  • Milk: Make sure that your child gets enough calcium from their diet—from milk or maybe some other dairy products. If by any chance your child is lactose intolerant, you can buy calcium supplements from a pharmacy.

Summary: The most common treatment for rickets is vitamin D. Vitamin D can be obtained through both diet and supplementation. The recommended dietary allowance (RDA) for vitamin D is 400 units for children and adults under the age of 50 and 600 units for those 51 and older. Some excellent dietary sources of vitamin D include egg yolks, fish, whole milk, and fortified breakfast cereals, among others.

What should my child eat while suffering from rickets?

The best foods to eat with rickets are foods replete with vitamin D, such as egg yolk, organ meats, fish, etc. Vitamin D can also be supplemented with cod liver oil and butter. All in all, the best diet for rickets is a balanced and nutrient-rich diet, along with plenty of vitamin D.

What should my child not eat while suffering from rickets?

Instead of rice, give your child cereal and milk. Junk food, fried food, and soda should be completely avoided. Foods that are great sources of calcium and vitamin D should be incorporated into your child’s regular diet. Low-fat milk, curd, and fruits are good sources of vitamin D. Vitamin D-rich foods and exposure to sunlight will aid your child's recovery from rickets.

Rickets Treatments

Rickets is a condition in which bones do not get enough calcium and phosphorus, which leads to soft and weak bones. This rare medical condition, which is mostly found in children, is treatable and can be cured completely. In fact, trusted supplements of calcium and vitamin D are among the most common rickets treatments.

Daily doses of vitamin D and calcium can strengthen bones and protect muscles from being weakened. If your child has rickets, you must make sure that their bones are getting enough calcium and vitamin D.

Apart from that, a child specialist or other healthcare professionals may prescribe calcium and phosphorus supplements to treat rickets caused by a vitamin D deficiency. For children who have severe rickets, doctors may even recommend surgery to lengthen the bones.

Surgery helps in restoring the normal alignment of large joints, such as the knee, hip, and ankle. Other orthopedic treatments include special shoes, casts, or braces to correct the deformity.

Summary: Rickets treatment options include surgery, medicines, and orthopedic treatments. Initially, a doctor will try to prevent calcium and vitamin D deficiencies by prescribing medications and changing the patient's diet. Surgery is an option if the patient doesn't respond to the above therapies.

Which doctor should I consult for rickets?

Rickets is essentially a condition of impaired bone development or a bone disorder that can cause weak and soft bones, mainly in kids. It must be diagnosed by a doctor who has experience diagnosing rickets. This rare condition is typically diagnosed using two x-rays of the bones and is confirmed with the help of a bone density test.

The treatment for rickets is usually a combination of calcium as well as vitamin D supplements. There is no need to be apprehensive about visiting a general physician or a child specialist if you think your child is suffering from rickets. That said, if you are still unable to recover from rickets despite adequate treatment, you must consult a pediatrician.

Pediatricians, according to studies, are more qualified to treat rickets in children. So, if you can, consult with a doctor who specializes in pediatric medicine for the treatment of rickets or other similar conditions.

What are the best medicines for rickets?

Rickets is a childhood disease that affects bone development. This rare condition mainly stems from a lack of vitamin D, phosphorus, or calcium. Furthermore, it can be treated with certain calcium and vitamin D supplements, and sometimes a phosphate supplement is also required.

Doctors may also prescribe antibiotics if an infection such as pneumonia is causing the rickets. Other medicines that can be used to treat rickets include alfacalcidol (Deltalin), calcitriol (Rocaltrol), and paricalcitol (Zemplar).

How long does it take to recover from Rickets?

Rickets is a disorder that results in the softening of bones and stunted growth. It is caused by a deficiency in vitamin D. Symptoms usually start appearing in kids who are between the ages of 6 months and 5 years.

This condition is characterized by bowed legs, a large fontanel, and flat feet. Rickets can be prevented by having a diet rich in calcium and vitamin D. Treatment usually involves the regular intake of calcium and vitamin D supplements.

The process of recovery usually takes several days to several weeks, predominantly depending on the severity of the patient's condition. Having said that, some cases may also take several months, a year, or even longer for complete recovery. There is no way that a person (or medical professional) can predict how long it may take for a rickets patient to fully recover.

Are the results of the treatment permanent?

The results of the Rickets treatment can be everlasting, but it’s always a good idea to go back to the doctor to make sure that there are no underlying issues. If your doctor finds that you are not absorbing the vitamins and minerals properly, your child may have to undergo additional treatment.

The treatments are usually not permanent, but they are lasting. Many children will relapse at some point in their lives. For a few, the treatment may be permanent.

The effects largely depend on the severity of the disease and the type of treatment. In some cases, even the cure may have its effects reversed by malnutrition and/or physiological stress. But then again, it is not very common.

Who is eligible for the treatment?

Rickets is a disease common in children under the age of five. There are two main types of rickets: nutritional rickets, caused by a lack of vitamin D, and hypophosphatemic rickets, caused by an imbalance of phosphorus and calcium. The good news is that all these types of rickets are treatable.

Hypophosphatemic rickets is a genetic disease that affects the way the body absorbs and uses these nutrients, affecting the development of bones, teeth, and other organs. Kids with the most severe rickets might have deformed or weak bones, have slow growth, or have weight loss.

Those with a mild case may have just a temporary body deformity or a few teeth affected. In either case, it is crucial that the kids get the necessary treatment as soon as possible. All in all, any kid who is diagnosed with rickets is eligible for treatment.

Who is not eligible for the treatment?

Rickets treatment is available in three forms, such as with the help of sunlight, diet, and pills (or medication). Women who are pregnant or breastfeeding are not eligible for the rickets treatment with pills or diet.

Instead of that, they are supposed to get sunlight exposure. On the other hand, individuals (or kids) who are allergic to sunlight or take medications that make them sensitive to sunlight are not eligible for the rickets treatment with the help of pills or diet.

What are the post-treatment guidelines?

The post-rickets treatment guidelines would vary from child to child, depending on their disease’s severity. Milder cases of rickets can be treated with a normal diet and vitamin D supplements. In severe cases, however, it is always advisable to consult a doctor or healthcare professional.

What is the cost of rickets treatment in India?

The starting cost of rickets treatment in India can be anywhere from 2,500 to 5,000 INR. Further treatment costs vary depending on the severity of the symptoms and the location of treatment. It's always a good idea to consult with an expert in this regard.

What are the side effects of rickets treatments?

If a child with rickets is treated, the teeth and bones may still be affected because the bones have already been weakened. The teeth may not come in properly and may be very thin and weak, so they break easily. They may also be discolored, crooked, and spaced apart.

Rickets: Outlook / Prognosis

Rickets is a health problem that can be prevented by giving children enough Vitamin D, especially during the first year of life. It must be noted that vitamin D is not stored in the body, so it needs to be replenished daily.

Furthermore, you must be surprised to learn that rickets was once very common in northern countries during the winter months, when people did not get enough vitamin D. Even today, most cases of this rare disease are found in developing countries, where people may not have access to enough vitamin D.

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Written ByDr. Amit C MD - Physical Medicine & RehabilitationPediatrics
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