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Rickets Making a Comeback
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Posted on: 09/13/2007
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Rickets, a disorder resulting from insufficient vitamin D, is making a come back in Western countries. A significant portion of Vitamin D can be had from a most natural source, the sun, but with today's avoidance of the sun because of skin cancer fears, this option has become less popular. As people cover up from fear or cultural practices, avoid the sun by staying inside, and use sunscreen, the sun's rays are not able to provide the necessary nutrients.
Pregnant women who don't get enough vitamin D while carrying the child may have children who develop bone mass problems. As well, as breast feeding rates rise, the breastfed babies should receive vitamin D supplements because vitamin D is not passed through breast milk. Finally, as children get older, they tend not to eat the foods that are highest in vitamin D, such as salmon, broccoli, or parsley. Even vitamin D enriched milk may be pushed aside in favor of soft drinks or soda. This provides a double whammy because not only do these drinks not have vitamin D, they can help prevent the absorption of some nutrients needed for bone building.
Taking all this information into account, researchers reviewed the causes of nutritionally-caused and inherited rickets. When looking at vitamin D absorption from the sun, the researchers noted that a sufficient amount of vitamin D would be absorbed within 30 minutes per week for a baby wearing only a diaper, or 2 hours per week for a fully clothed child who is not wearing a hat. People with darker skin do need a bit more time because of the melanin in the skin.
As children grow, their bones form bone mass. Children with rickets are unable to form that mass and this causes softening of the bones, often seen as the bow-legged image that many people have seen. The start of rickets may be seen by x-ray by how the bones are forming and bending out of shape. It's most obvious around the wrists, knees, and ankles. Once a child with rickets begins to walk, the problems may become more obvious if they haven't been picked up. Children can also end up with kyphoscoliosis, or a humped back curve of the spine. This happens because the vertebrae, the bones in the spine, are too soft to support the upright weight of the body. Other problems include craniotabes, or softening of the skull bones, a delay in the closing of the anterior fontanelle, or soft spot on the skull, and increased pressure in the skull.
Other parts of the body can be affected as well. They include the teeth and this particular effects seems most common with rickets from pregnancy vitamin D deficiency. The enamel on the teeth may not be strong, the appearance of teeth can be delayed, and there can be an increase in dental abscesses or infections. Children under 6 months old can develop seizures, changes in heart rhythm, and muscle weakness.
As one might think, the treatment for rickets is by providing the needed vitamin D. However, how the vitamin is given depends on the cause. A medication called ergocalciferol is used to treat an acute deficiency of vitamin D, usually daily for 2 to 4 months. Other medications, such as alphacalcidol or calictrol are used for children who have severe kidney or liver problems. If a child is also lacking in calcium, that can be given as a supplement, by mouth.
If the rickets are hypophosphataemic, meaning the child doesn't have enough phosphate, also needed for building bone, this can be given by mouth. The child does need to be monitored closely because too much phosphate can cause calcium to be eliminated from the body through the urine.
An important point the authors noted was that if a child with rickets needs surgery to correct a bone problem, the rickets must be dealt with first.
When doctors are dealing with neonatal rickets, those caused by lack of vitamin D during pregnancy, the babies will receive calcium gluconate to prevent seizures. First given by intravenous, it is switched to an oral, by mouth, form as soon as possible as the IV formulation is hard on the vein walls. The treatment can be effective within 72 hours but can also take as long as 10 days.
Premature babies also have a higher chance of developing rickets because of how fast they grow; the minerals in their bodies don't seem to be able to keep up with the rate of growth. Another issue with rickets is lack of movement. People who don't move can begin to lose bone mass. Children with rickets can't afford to lose bone mass while being immobile, so physiotherapy is usually ordered. However, this must be done with care because the fragile state of the bones can result in a fracture, or break, which, of course, leads to more immobility.
The authors conclude by pointing out again the increase in the rate of rickets in Western Europe and the United States. They review the importance of recognizing rickets, particularly the rarer forms, in order to begin treatment as early as possible. The importance of education must be emphasized so that children and parents can make the proper food choices.
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References:
Paul Dimitri and Nick Bishop. Rickets: new insights into a re-emerging problem. In Current Opinion in Orthopaedics. September 2007. Vol. 18. No. 5. Pp. 486-493.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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