Diagnostic Radiology/Musculoskeletal Imaging/Metabolic Basic/Rickets

Rickets is a disorder of infancy and early childhood of multiple etiologies. Rickets, causing soft bones, may occur if enough vitamin D is not present to assist in calcium absorption. When enough calcium is not absorbed by the bone, it does not harden properly, and is too soft to support the weight of the growing body properly. The disease of rickets takes its name from the Greek word for spine, rhakhis.

X-ray of the legs in a two-year-old child with rickets

Etiology

Vitamin D is made by the body when it is exposed to ultraviolet light (which is found in sunlight). Vitamin D is also added to milk, milk products, and multi-vitamin pills through a process originally patented by Harry Steenbock. Some people who do not get enough sun exposure, milk products, or green vegetables may also develop the disease. Deficiency of calcium can also cause rickets, particularly in some developing countries where the intake of calcium-rich products such as leafy greens, nuts, and seeds is low.

Hereditary rickets, is caused by an inherited disease that interferes with the resorption of renal tubular phosphate in the kidney. Rickets can also be caused by certain liver diseases.

A similar disorder can occur in adults, and is called osteomalacia. Then, it is caused by the inability of bone cells to calcify, or harden. Less frequently, nutritional shortage of calcium or phosphorus may produce rickets.

Manifestations of disease

Rickets causes bone pain, slowed growth in children, dental problems, muscle loss and increased risk of fractures (easily broken bones). Medical problems seen in children with rickets are

Vitamin D deficiency,
Skeletal deformity,
Growth disturbance,
Hypocalcemia (low level of calcium in the blood),
Tetany (uncontrolled muscle spasms).

The X-ray, or radiograph, in the article is the classic image of advanced rickets sufferers: bow legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life.

Treatment and prevention

Treatment involves increasing dietary intake of calcium, phosphates and Vitamin D. Exposure to sunshine, cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D.

A sufficient amount of sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned babies need to be exposed longer to the ultraviolet rays. The replacement of Vitamin D may correct rickets using these methods of ultraviolet light and medicine.