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Rickets and Osteomalacia En Español (Spanish Version)
Rickets (in children) and osteomalacia (in adults) are two forms of a metabolic bone disease resulting from
vitamin D
deficiency. Both cause softening and weakening of bones because of defective or inadequate bone mineralization.
Rickets © 2011 Nucleus Medical Media, Inc.
Rickets and osteomalacia result when there is a vitamin D deficiency in the body. This may occur when:
- The supply of vitamin D from the diet or sun exposure is inadequate.
- The metabolism of vitamin D is abnormal.
- Tissue is resistant to the action of vitamin D.
Vitamin D
regulates
calcium
absorption in the body. It also controls levels of calcium and phosphate in bone. Vitamin D is absorbed in the intestines from food. Vitamin D is also produced by the skin during exposure to sunlight.
Most often, rickets and osteomalacia are caused by a deficiency of vitamin D. This can result from:
-
Insufficient vitamin D in the diet. In children, this may be related to:
- Insufficient consumption of vitamin D-fortified milk
-
Insufficient intake of vitamin D supplements to children being breastfed or to children who are
lactose intolerant
- Lack of exposure to sunlight.
Less often, rickets and osteomalacia can be caused by other disorders that affect vitamin D absorption, metabolism, or action in the body such as:
-
Kidney problems:
- A hereditary disorder of the kidney called vitamin D-resistant rickets
- Renal tubular acidosis—a nonhereditary kidney disorder which causes bone calcium to dissolve
-
Chronic
kidney failure
-
Long-term kidney
dialysis
-
Diseases of the small intestines with
malabsorption
- Disorders of the liver or pancreas disease
- Cancer
-
Certain drugs, such as:
-
Toxicity or poisoning from:
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for rickets/osteomalacia include:
- Lack of sun exposure
-
Age in children: 6 to 24 months old
- Babies who are breastfed (Breast milk is low in vitamin D.)
- Babies who do not consume enough formula that is fortified with vitamin D
- Children who do not drink enough vitamin D fortified milk
- Age in adults: 50-80 years
- Lactose intolerance with inadequate intake of vitamin D-fortified milk
- Family history of rickets
- Race: Black, especially in association with breastfeeding
Symptoms may include:
- Bone pain and tenderness
- Skeletal and/or skull deformities
- Bow legs or knock knees
- Deformity or curvature of the spine
- Pigeon chest (forward protrusion of the chest bone)
- Impaired growth, resulting in short stature
- Susceptibility to bone fractures
- Dental deformities
- Delayed tooth formation
- Defects in teeth
- Increased cavities
- Loss of appetite or weight loss
- Difficulty sleeping
- Poor muscle development and tone
- Muscle weakness
- Delay of learning to walk in children
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests to confirm the diagnosis may include:
- Blood and urine tests
- X-ray
—a test that uses radiation to take a picture of structures inside the body, in this case, bones
-
Bone
biopsy
(when other tests are not conclusive)
Treatment attempts to:
- Correct the underlying cause
- Relieve or reverse symptoms
Treatment of the underlying cause may include:
-
Adding the following to your diet:
- Vitamin D-fortified dairy products
- Foods high in vitamin D (such as fatty fish, egg yolk, and green vegetables)
- Supplements of vitamin D, calcium, and other minerals
- Biologically active vitamin D
- Adequate but not excessive exposure to sunlight
Treatment to relieve or correct symptoms may include:
- Wearing braces to reduce or prevent bony deformities
- In severe cases, surgery to correct bony deformities
To help prevent rickets or osteomalacia:
- Drink vitamin D-fortified milk.
-
Consume
sufficient
vitamin D
, calcium, and other minerals. If you think your diet may be deficient, talk with your doctor about alternate sources of vitamins and minerals.
- Get sufficient, but not excessive, exposure to sunlight. Fifteen minutes a day is usually considered sufficient. Any longer than that requires sun protection with clothing or sunscreens, especially in fair-skinned infants or children. Children with dark skin and their mothers are at increased risk for rickets and may need more sun exposure and dietary supplementation with vitamin D.
- Breastfed babies and bottlefed babies who do not get enough vitamin-D fortified formula may need to be given a supplement starting within the first few days of life. Children not getting at least 400 units of vitamin D from their diet may also need supplements. Talk to the doctor to make sure your child is meeting the nutritional requirements for vitamin D.
American Academy of Pediatrics American Dietetic Association Alberta Children's Services
Balk SJ; Council on Environmental Health; Section on Dermatology. Ultraviolet
radiation: a hazard to children and adolescents.
Pediatrics.
2011;127(3):e791-817.
Berkow R, Beers MH, Fletcher AJ, Bogin RM.
The Merck Manual of Medical Information—Home Edition
. New York, NY: Simon and Schuster, Inc; 2000.
Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/
. Accessed July 14, 2009.
Grant WB, Boucher BJ. Requirements for Vitamin D across the life span.
Biol Res Nurs.
2011;13(2):120-133.
Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.
Pediatrics.
2008;122:1142-1152.
Last Reviewed September 2011
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