Rickets

Definition:
Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries. The predominant cause is a vitamin D deficiency, but lack of adequate calcium in the diet may also lead to rickets (cases of severe diarrhea and vomiting may be the cause of the deficiency). Although it can occur in adults, the majority of cases occur in children suffering from severe malnutrition, usually resulting from famine or starvation during the early stages of childhood. Osteomalacia is the term used to describe a similar condition occurring in adults, generally due to a deficiency of vitamin D. The origin of the word “rickets” is probably from the Old English dialect word ‘wrickken’, to twist. The Greek derived word “rachitis” (paXiTig, meaning “inflammation of the spine”) was later adopted as the scientific term for rickets, due chiefly to the words’ similarity in sound.

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Types:-
*Nutritional Rickets
*Vitamin D Resistant Rickets
*Vitamin D Dependent Rickets
…#Type I
…#Type II
*Congenital Rickets

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Symptoms:

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Signs and symptoms of rickets may include:

•Bone pain or tenderness
…#Arms
…#Legs
…#Pelvis
…#Spine

•Dental deformities
…#Delayed formation of teeth
…#Decreased muscle tone (loss of muscle strength)
…#Defects in the structure of teeth; holes in the enamel
…#Increased cavities in the teeth (dental caries)
…#Progressive weakness

•Impaired growth
•Increased bone fractures
•Muscle cramps
•Short stature (adults less than 5 feet tall)

•Skeletal deformities
…#Asymmetrical or odd-shaped skull
…#Bowlegs
…#Bumps in the ribcage (rachitic rosary)
…#Breastbone pushed forward (pigeon chest)
…#Pelvic deformities
…#Spine deformities (spine curves abnormally, including scoliosis or kyphosis)

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Causes:
Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones. This leads to weak and soft bones.

Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D production by the skin may occur in people who:

•Live in climates with little exposure to sunlight
•Must stay indoors
•Work indoors during the daylight hours
You may not get enough vitamin D from your diet if you:

•Are lactose intolerant (have trouble digesting milk products)
•Do not drink milk products
•Follow a vegetarian diet
Infants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D. This can be a particular problem for darker-skinned children in winter months (when there are lower levels of sunlight).

Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in diet is rare in developed countries, because calcium and phosphorous are found in milk and green vegetables.

Your genes may increase your risk of rickets. Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis.

Problems with absorption
Some children are born with or develop medical conditions that affect the way their bodies absorb vitamin D. Some examples include:

*Celiac disease
*Inflammatory bowel disease
*Cystic fibrosis
*Kidney problems

Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth, when the body needs high levels of calcium and phosphate. Rickets may be seen in children ages 6 – 24 months. It is uncommon in newborns.

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Risk Factors:
*Age. Children 6 to 24 months old are most at risk of rickets because their skeletons are growing so rapidly.

*Dark skin. Dark skin doesn’t react as strongly to sunshine as does lighter colored skin, so it produces less vitamin D.

*Northern latitudes. Children who live in geographical locations where there is less sunshine are at higher risk of rickets.

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*Premature birth. Babies born before their due dates are more likely to develop rickets.

*Anti-seizure medications. Certain types of anti-seizure medications appear to interfere with the body’s ability to use vitamin D.

*Exclusively breast-fed. Breast milk doesn’t contain enough vitamin D to prevent rickets. The American Academy of Pediatrics recommends vitamin D drops for breast-fed babies

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Complications:
If left untreated, rickets may lead to:

*Failure to grow
*Skeletal deformities
*Bone fractures
*Dental defects
*Breathing problems and pneumonia
*Seizures

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Diagnosis:
A physical exam reveals tenderness or pain in the bones, rather than in the joints or muscles.

The following tests may help diagnose rickets:

•Arterial blood gases
•Blood tests (serum calcium)
•Bone biopsy (rarely done)
•Bone x-rays
•Serum alkaline phosphatase
•Serum phosphorus

Other tests and procedures include the following:

•ALP (alkaline phosphatase) isoenzyme
•Calcium (ionized)
•PTH
•Urine calcium

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Treatment:
The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated to prevent the disease from returning.

Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish, liver, and processed milk. Exposure to moderate amounts of sunlight is encouraged. If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed.

Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require corrective surgery.

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Prognosis:
The disorder may be corrected by replacing vitamin D and minerals. Laboratory values and x-rays usually improve after about 1 week, although some cases may require large doses of minerals and vitamin D.

If rickets is not corrected while the child is still growing, skeletal deformities and short stature may be permanent. If it is corrected while the child is young, skeletal deformities often improve or disappear with time.

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Prevention:
Most adolescents and adults receive much of their necessary vitamin D from exposure to sunlight. Infants and young children, however, need to avoid direct sun entirely or be especially careful by always wearing sunscreen.

Make sure your child is consuming foods that contain vitamin D naturally — fatty fish, fish oil and egg yolks — or that have been fortified with vitamin D, such as:

*Infant formula
*Cereals
*Milk
*Orange juice

Because human milk contains only a small amount of vitamin D, the American Academy of Pediatrics recommends that all breast-fed infants receive 400 international units (IU) of oral vitamin D daily beginning the first few days of life.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

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Resources:
http://www.mayoclinic.com/health/rickets/DS00813
http://www.nlm.nih.gov/medlineplus/ency/article/000344.htm
http://en.wikipedia.org/wiki/Rickets
http://trialx.com/curebyte/2011/05/24/images-related-to-rickets/

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