Causes of Rickets

Written by Yao Li Qin
Pediatrics
Updated on January 07, 2025
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Rickets, also known as Vitamin D-deficiency rickets, implies from its name that the cause of the disease is due to insufficient intake of Vitamin D in children, leading to disorders in calcium and phosphorus metabolism and resulting in nutritional disease with skeletal deformities. The incidence of the disease is higher in the north than in the south. Currently, the incidence of mild and moderate rickets is relatively high, while severe cases are less common because people are increasingly paying attention to the supplementation of Vitamin D for children. It is recommended that full-term infants start supplementing with 400 units of Vitamin D daily two weeks after birth, which is the physiological requirement. For premature infants, twins, and extremely low birth weight infants, the daily physiological requirement of supplementation is 800 units per day. After supplementing continuously for three months, it should be adjusted to 400 units per day as per the requirement for full-term infants. With such management, the child will not suffer from rickets. However, if there is no regular supplementation after birth, the lack of Vitamin D can lead to skeletal changes in the child, and once rickets is diagnosed, it requires high doses of supplementation.

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How to determine if a baby has rickets

The diagnosis of rickets in infants should rely on the level of 25-hydroxyvitamin D3 in the blood and the examination of the long bones through X-rays imaging, rather than early symptoms. However, due to the young age of infants, it is recommended to supplement vitamin D within two weeks after birth. If the supplementation is not timely, some early clinical manifestations may appear occasionally, such as brachycephaly, bowed legs, and pigeon chest in infants. Additionally, there may be abnormalities in the nervous system, such as unstable sleep, easily startled and crying, and increased excitability. Therefore, it is necessary to identify the condition through the aforementioned tests and then proceed with symptomatic treatment.

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Rickets is a disease that affects bone development in children due to vitamin D deficiency, calcium, or phosphate. It is treatable with proper nutrition and supplementation.

Rickets, also known as vitamin D deficiency rickets, is caused by a lack of vitamin D, leading to abnormal calcium and phosphorus metabolism in the body. The calcium salts cannot be properly deposited in the growing parts of the skeleton, causing incomplete mineralization of the bone tissue during growth. This results in a chronic systemic nutritional disease closely related to lifestyle, characterized by skeletal abnormalities. The most common is nutritional vitamin D deficiency, which is self-limiting. Typically, sufficient vitamin D supplementation and appropriate sun exposure can cure it. If caused by other severe diseases, vitamin D deficiency will significantly manifest liver and kidney function abnormalities. Additionally, some congenital genetic diseases make treatment more difficult when vitamin D levels are deficient.

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How is rickets diagnosed?

Rickets is a chronic nutritional disease characterized by skeletal changes, resulting from insufficient Vitamin D in children, which leads to disruptions in calcium and phosphorus metabolism. Diagnosis of rickets requires a measure of Vitamin D levels, clinical manifestations, certain biochemical markers in blood, and skeletal X-ray findings. Typically, Vitamin D levels are significantly lower than usual, with the level of 25-hydroxyvitamin D3 being the most reliable diagnostic standard. However, many facilities are unable to perform this test, so some instead rely on blood biochemistry and skeletal X-rays. Currently, blood biochemistry and skeletal X-ray examinations are considered the gold standard for diagnosis.

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Can rickets be treated?

Rickets is a disorder caused by a deficiency of vitamin D, leading to impaired calcium and phosphorus absorption, which then results in abnormal skeletal development. It is a chronic nutritional disease. Generally, the rickets commonly mentioned is due to nutritional vitamin D deficiency, which is treatable. Typically, encouraging children to engage in appropriate physical activities while supplementing with an adequate level of vitamin D can effectively control the disease, and it can even be cured. However, if there are special circumstances, such as significant liver abnormalities, renal function abnormalities, renal failure, or abnormalities in the thyroid or parathyroid glands, including parathyroid tumors, or congenital hereditary diseases, the treatment needs to be based on the cause in order to effectively control the disease and promote normal calcium and phosphorus metabolism in the body. Congenital hereditary diseases generally make treatment more challenging. Therefore, it is crucial for children with rickets to seek timely medical examination at a hospital. If it is a common case of nutritional vitamin D deficiency, parents should supplement vitamin D promptly according to the doctor's advice for treatment.

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The difference between rickets and rib flare

Rickets and rib flaring are different; rib flaring can be considered a symptom of rickets. Rickets is caused by a deficiency of vitamin D in infants and children, leading to abnormal metabolism of calcium and phosphorus, which results in incomplete calcification and softening of the bones, thereby causing skeletal deformities. Rickets can be divided into initial, active, recovery, and sequelae stages. During the active stage of rickets, skeletal deformities such as softened skull, "ping pong" head, square skull, rib flaring, pigeon chest, funnel chest, X-shaped legs, and O-shaped legs are prone to occur.