Signs and Symptoms of Rickets

Rickets manifests in several different ways. A baby might seem “floppy”, or floppier than normal. A child may complain of bone tenderness or pain, or they may be resistant to walking or tire easily. Bones affected by rickets break easily, so if a child breaks a lot of bones that could be a sign of rickets. Rachitic rosary, the enlarged ends of ribs that appear beadlike, and Harrizon’s groove, a horizontal line that is seen where the diaphragm attaches to the ribs, and also signs of rickets.

In this image, both rachitic rosary and Harrizon's groove are visible. The bead-like bumps on the baby's chest is rachitic rosary, and the line on his abdomen in Harrizon's groove.

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Additionally, hypocalcemia, or low blood calcium levels, can indicate rickets. If the calcium levels are low enough, it may cause muscle cramps, twitching, tingling, or even seizures (though this is rare).  A parent might notice soft spots in a child’s skull that otherwise shouldn’t be there. A child’s wrists and ankles may begin to widen, or there may be other spinal, pelvic, or cranial deformities. The height and weight of a child can also be affected by rickets, the child will be shorter and lighter. Muscle weakness may be a sign of rickets as well. Due to the poor absorption of calcium, dental deformities or delayed dental growth may appear. The enamel on the teeth will be weak, so there is an increased risk for cavities. As I’ve mentioned before, a protruding breast bone, or pigeon chest, and bowed legs are some of the most well-known rickets symptoms. Rickets symptoms and signs are mainly physical, making it fairly easy to identify the need for medical help.

For more information please read http://www.medicalnewstoday.com/articles/176941.php or http://www.medicinenet.com/rickets/page3.htm#what_are_rickets_symptoms_and_signs

Rickets Diagnosis

Rickets is diagnosed in a clinical setting by professionals. Initially, a doctor may press gently on the child’s bones to see if they’re soft. In particular, they’ll observe the skull, legs, chest, wrists, and ankles. Children with rickets often have softer skulls, bowed legs, a pigeon chest, and wider and thicker wrists and ankles. A pigeon chest is when the chest begins to flatten causing the breastbone to protrude. 

The physical manifestations of rickets are illustrated here. The pigeon chest, wide joints, bowlegs, and spine deformities are a few prominent features. 

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If rickets is suspected, a blood test will be done. This test will measure the levels of calcium and phosphorus in the body. A test may also be done to measure the amount of parathyroid hormone. If the levels of parathyroid hormone are high, that means there isn’t enough calcium in the blood and the body will start taking it from the bones. X-rays of long bones may also be taken. The x-rays and blood tests results are taken into consideration, and if the signs are all there, the child is diagnosed with rickets.

With treatment, rickets is easy to cure. But if it goes untreated, it can lead to long-term skeletal deformities, an abnormally curved spine, or dental defects. It can also poor growth.

For more information on Vitamin D and Rickets, please read: http://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro

Rickets Pathophysiology

Rickets is a disease that directly results from a lack of Vitamin D and the improper mineral absorption that comes from response to that. If not enough Vitamin D is ingested, calcium and phosphorus cannot be absorbed. These minerals are crucial in the formation and maintenance of healthy and strong bones. Low Vitamin D levels leads to low calcium absorption in the intestines. In order to make up for this, the body will increase levels of Parathyroid Hormone (or PTH) which signals the body to increase levels of calcium. The body will them begin to reabsorb calcium from its own bones.  A disruption in the homeostasis (or equilibrium) of calcium and phosphorus causes poor calcification (or accumulation of calcium) of the cartilage in growing long bones such as the femur. This is what contributes to the bowing of the legs. The bones are weaker and less dense because not enough calcium has been brought together. Thus, it is more likely for the bones to bend.  

These legs are affected by rickets, and display bowed legs.

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Additionally, rickets can cause the widening of wrist or the splaying of bones. The bones may be widening in attempt to compensate in size for what they lack in strength. This doesn’t do much to help however, bone stability is not enhanced.

For more information, please read:

http://emedicine.medscape.com/article/985510-overview#a5
                                   or
http://www.uptodate.com/contents/overview-of-rickets-in-children

What is Rickets?

The term "rickets" is derived from an old English word, meaning to bend or twist, which is essentially what happens to bones with this disease. To bring it into modern terms though, the Mayo Clinic defines rickets as "the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency." A form of this disease is also present in adults, called osteomalacia. Unlike osteoporosis which results when bones weaken with age, is a result from weak bones early in childhood. We have all been taught from a young age that calcium plays a large role in the development of strong and healthy bones. What we may not have known however, is that Vitamin D is also a crucial nutrient for bone development. In order for the body to be able to use and absorb calcium, as well as phosphorus (another important mineral), the body needs Vitamin D. As the food we eat travels through our intestines, the nutrients that our body need to function are pulled out. Vitamin D aids in that process.  If the body doesn’t have enough Vitamin D, it'a likely that the body won't be able to maintain the necessary levels of calcium and phosphorus, and as a result will be unable to support normal bone development. Since our bodies can not create calcium on it's own, Vitamin D becomes even more important. Without Vitamin D, bones are more prone to deformities or fractures, often resulting in bowed legs. 

Look! The bones with normal anatomy are straight, whereas the bones affected by rickets are slanted or bowed. The lack of Vitamin D, Calcium, and Phosphorus cause the bones to be more fragile and prone to fractures.

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While rickets have nearly been eradicated from developed countries such as the United States of America, it's still a prevalent in less developed countries. It's completely and entirely preventable and with proper education and knowledge, can be eradicated fully.