RICKETS is a common cause for weak bones.

• In rickets, there is the decreased density of bone.

• Bone is made of a protein inner structure and calcium deposit on it.

• As you know babies are born with lot many bones. These bones fuse to one another over the years.

• Vitamin D is very important for Calcium and phosphorus absorption.

• Hence low levels of Vitamin D can cause rickets as body fails to absorb calcium.

• Part of vitamin D is formed in the liver and kidney. Hence chronic liver and kidney problems present with low bone density.

• Sunlight is important for activation of Vitamin D. Hence Exposure to the sun is important for bone health.

• The quantity of sunlight absorbed also depends on the skin pigmentation. Individuals with increased skin pigmentation may need more sunlight. Sunscreens decrease sunlight absorption

 

CAUSES of RICKETS

Vitamin D deficiency-

• Due to the decreased intake.

• Decreased sunlight exposure

• Chronic kidney/ Liver problems

 

Calcium/ Phosphorus deficiency –

• Due to inadequate intake

• Kidney problems- where kidneys fail to absorb calcium.

 

Vitamin D deficiency in the mother when pregnant is a risk for the baby being Deficient too.

 

• History of delayed dentition, dental caries, poor growth, delayed walking skills

• Hence important to maintain Growth charts until 5 years of age at least.

• Baby may have delayed closure of fontanelle (soft spot on head open beyond 2 years of age)

• Thin rib bones

• Enlarged wrist joint or ankle joint or even bowing of legs

• Severe deficiency may present with Fits( especially in babies)

 

TESTS to diagnose Rickets-

• The clinical features are numerous and hint the diagnosis.

• Blood tests are done to determine mineral levels(calcium, phosphorus) and vitamin D levels

• Wrist X-rays- so see features of reduced bone density

• Kidney function blood tests

 

TREATMENT

Vitamin D deficiency is treated by giving Vitamin D –

• This is given either oral vitamin tablets for 1-2 months or as injections for 1-2 days.

• This is followed by ensuring adequate vitamin intake either as food or supplement

Calcium and phosphorus deficiency-

• Corrected by medications

Kidney problems need follow up and regular monitoring by kidney doctors.

 

PRETERM RICKETS

• Babies born early (< 37 weeks gestation) are increased the risk for rickets.

• Calcium, phosphorus are transferred to the baby in the last few months during pregnancy. If the baby is born early, then the child loses these minerals.

• These babies are generally started on Vitamin D supplements until they are 3- 3.5 kilograms.

• Talk to your doctor if any concerns and before any medication

 

DIET RICH IN VITAMIN D

• Fish, Liver Oils

• Egg yolk

• Cheese

• Many foods are being fortified( topped up) with vitamin D

 

DIET RICH IN CALCIUM

• Dairy products- Milk, Cheese, Yogurt

• Green leafy vegetables- Spinach, Kale

• Soybeans

• Some fish, like sardines, salmon