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| {{Infobox Disease | | {{ Rickets }} |
| | Name = Rickets
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| | ICD10 = {{ICD10|E|55| |e|50}}
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| | ICD9 = {{ICD9|268}}
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| | Image = Rickets USNLM.gif
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| | Caption = A family with rickets. Paris, 1900.
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| | DiseasesDB = 9351
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| | MedlinePlus = 000344
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| | MeshName = Rickets
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| | MeshNumber = D012279
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| }} | |
| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| ==Overview== | | ==[[Rickets overview|Overview]]== |
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| '''Rickets''' is a softening of the bones in children 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. 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.
| | ==[[Rickets historical perspective|Historical Perspective]]== |
| [[Osteomalacia]] is the term used to describe a similar condition occurring in adults, generally due to a deficiency of vitamin D.
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| The origin of the word "rickets" is unknown. The Greek derived word "rachitis" (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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| ==Epidemiology== | | ==[[Rickets classification|Classification]]== |
| [[Image:Rickets wrist.jpg|thumb|left|"rachitis" The "wrist widening" of rickets]] | |
| Those at higher risk for developing rickets include:
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| *Breast-fed infants whose mothers are not exposed to sunlight
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| *Breast-fed infants who are not exposed to sunlight
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| *Individuals not consuming fortified milk, such as those who are [[lactose intolerant]]
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| Individuals with red hair have a decreased risk for rickets due to their greater production of vitamin D in sunlight.<ref>[http://www.derm.med.ed.ac.uk/06_teaching/redhairgen.htm Red hair and genetics]</ref>
| | ==[[Rickets pathophysiology|Pathophysiology]]== |
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| ==Etiology== | | ==[[Rickets causes|Causes]]== |
| Vitamin D is required for proper calcium absorption from the gut. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in [[hypocalcemia]], leading to skeletal and dental deformities and [[neuromuscular]] symptoms, e.g. hyperexcitability.
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| A rare [[X-linked dominant]] form exists called [[X-linked hypophosphatemia|Vitamin D resistant rickets]].
| | ==[[Rickets differential diagnosis|Differentiating Any Disease from other Diseases]]== |
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| ==Presentation== | | ==[[Rickets epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Image:XrayRicketsLegssmall.jpg|thumb|left|[[Radiograph]] of a two-year old rickets sufferer, with a marked [[genu varum]] (bowing of the [[femur]]s) and decreased bone [[opacity]], suggesting poor [[bone mineralization]].|right]]
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| Signs and symptoms of rickets include:
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| *Bone pain or tenderness
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| *[[tooth|dental]] problems
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| *[[muscle]] weakness (rickety myopathy or "floppy baby syndrome")
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| *increased tendency for [[fracture]]s (easily broken bones), especially [[greenstick fracture]]s
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| *Skeletal deformity
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| **Toddlers: Bowed legs ([[genu varum]])
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| **Older children: Knock-knees ([[genu valgum]]) or "windswept knees"
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| **Cranial, spinal, and pelvic deformities
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| *Growth disturbance
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| *[[Hypocalcemia]] (low level of calcium in the blood), and
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| *[[Tetany (medical sign)|Tetany]] (uncontrolled muscle spasms all over the body).
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| *[[Craniotabes]] (soft skull)
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| *[[Costochondral]] swelling (aka "[[rickety rosary]]" or "[[rachitic rosary]]")
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| *[[Harrison's groove]]
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| *Double malleoli sign due to metaphyseal hyperplasia [http://medicalpics.blogspot.com/2007/04/double-malleoli-sign-of-rickets.html]
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| An [[X-ray]] or [[radiography|radiograph]] of an advanced sufferer from rickets tends to present in a classic way: 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 if not treated.
| | ==[[Rickets risk factors|Risk Factors]]== |
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| Long-term consequences include permanent bends or disfiguration of the long bones, and a [[Scoliosis|curved back]].
| | ==[[Rickets screening|Screening]]== |
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| | ==[[Rickets natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| A doctor may diagnose rickets by:
| | [[Rickets history and symptoms|History and Symptoms]] | [[Rickets physical examination|Physical Examination]] | [[Rickets laboratory findings|Laboratory Findings]] | [[Rickets electrocardiogram|Electrocardiogram]] |[[Rickets chest x ray|Chest X Ray]] | [[Rickets CT|CT]] | [[Rickets MRI|MRI]] | | [[Rickets other imaging findings|Other Imaging Findings]] | [[Rickets other diagnostic studies|Other Diagnostic Studies]] |
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| *Blood tests:
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| **Serum [[calcium]] may show low levels of calcium, serum [[phosphorus]] may be low, and serum [[alkaline phosphatase]] may be high.
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| *[[Arterial blood gas]]es may reveal [[metabolic acidosis]]
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| *[[X-ray]]s of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones.
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| *Bone biopsy is rarely performed but will confirm rickets.
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| '''Patient #1: Radiographs of the knee in a patient with rickets'''
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| <gallery>
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| Image:Rickets-001.jpg
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| Image:Rickets-002.jpg
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| </gallery>
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| '''Patient #2: Radiographs of the knee in a patient with rickets'''
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| <gallery>
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| Image:
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| Rickets-201.jpg
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| Image:
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| Rickets-202.jpg
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| </gallery>
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| '''Patient #3: Radiograph of the chest in a patient with rickets'''
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| <gallery>
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| Image:
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| Rickets-301.jpg
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| </gallery>
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| ==Ricketts: Microscopical Findings==
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| {{#ev:youtube|y7iA0_jkOTI}}
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| ==Treatment and prevention==
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| ===Diet and sunlight===
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| [[Image:Cholecalciferol.png|thumb|left|[[Cholecalciferol]] (D3)]] | |
| [[Image:Ergocalciferol.png|thumb|left|[[Ergocalciferol]] (D2)]]
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| Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet light (sunshine), [[cod liver oil]], halibut-liver oil, and [[Ergosterol|viosterol]] are all sources of vitamin D.
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| A sufficient amount of ultraviolet in 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|ultraviolet rays]]. The replacement of vitamin D has been proven to correct rickets using these methods of [http://pediatrics.aappublications.org/cgi/content/full/112/2/e132 ultraviolet light therapy]and medicine.
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| Recommendations are for 200 [[international unit]]s (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance.
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| ===Supplementation===
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| Sufficient vitamin D levels can also be achieved through dietary supplementation. Vitamin D3 ([[cholecalciferol]]) is the preferred form since it is more readily absorbed than vitamin D2. Most [[dermatology|dermatologists]] recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of skin cancer associated with sun exposure.
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| According to the [[American Academy of Pediatrics]] (AAP), infants who are breast-fed may not get enough vitamin D from breast milk alone. For this reason, the AAP recommends that infants who are exclusively breast-fed receive daily supplements of vitamin D from age 2 months until they start drinking at least 17 ounces of vitamin D-fortified milk or formula a day [http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/908]. This requirement for supplemental vitamin D is not a defect in the evolution of human breastmilk but is instead a result of the modern-day infant's decreased exposure to sunlight.
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| == References ==
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| {{reflist|2}}
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| <references/>
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| == External links == | | ==Treatment== |
| *[http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/908 AAP Recommendations on Vitamin D Supplementation]
| | [[Rickets medical therapy|Medical Therapy]] | [[Rickets surgery|Surgery]] | [[Rickets primary prevention|Primary Prevention]] | [[Rickets secondary prevention|Secondary Prevention]] | [[Rickets cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Rickets future or investigational therapies|Future or Investigational Therapies]] |
| *[http://courses.washington.edu/bonephys/hypercalU/opmal2.html Dr. Susan Ott's website on osteomalacia]
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| *[http://www.healthvitaminsguide.com/deficiencies/rickets.htm Rickets - Symptoms, Causes, Treatment]
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| *[http://dictionary.reference.com/search?q=osteomalacia Dictionary.com - Osteomalacia]
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| *[http://www.fluoridealert.org/health/bone/fluorosis/osteomalacia.html Fluoride & Osteomalacia]
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| *[http://www.beyonddiscovery.org/content/view.txt.asp?a=414 History of Vitamin D and the battle against Rickets]
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| * {{Chorus|00906}}
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| {{Nutritional pathology}}
| | ==Case Studies== |
| | [[Rickets case study one|Case #1]] |
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| [[Category:Malnutrition]]
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| [[Category:Pediatrics]]
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| [[Category:Skeletal disorders]]
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| [[Category:Gastroenterology]]
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| [[de:Rachitis]] | | [[Category:Projects]] |
| [[es:Raquitismo]] | | [[Category:Help]] |
| [[fi:Riisitauti]]
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| [[fr:Rachitisme]]
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| [[ko:구루병]]
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| [[it:Rachitismo]]
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| [[ja:くる病]]
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| [[nl:Rachitis]]
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| [[no:Rakitt]]
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| [[pl:Krzywica]]
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| [[pt:Raquitismo]]
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| [[ru:Рахит]]
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| [[simple:Rickets]]
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| [[sv:Rakitis]]
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| [[tr:Raşitizm]]
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| [[zh:佝僂病]]
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