Rickets - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Rickets is deficient mineralization at the growth plate of long bones, resulting in faltering growth. If the underlying condition is not treated, bone deformity occurs, typically causing bowed legs and thickening of the ends of long bones.
Rickets only occurs in growing children before fusion of the epiphyses, and typically affects the wrists, knees, and costochondral junctions.
Rickets occurs primarily as a result of a nutritional deficiency of vitamin D, but can be associated with nutritional deficiencies of calcium or phosphorus. Hypophosphatemic rickets is a common genetic cause of rickets.
The mainstay of treatment is to correct vitamin D deficiency and to ensure adequate calcium intake.
Vitamin D deficient rickets can be prevented in many cases by ensuring that children and pregnant women have sufficient vitamin D and calcium intake.

Malnutrition manifested as rickets. Note the bowed legs and enlarged right wrist

CDC

Malnutrition manifested as rickets. Note the bowed legs and knees

CDC

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Malnutrition manifested as rickets. Note the bowed legs and enlarged right wrist
Malnutrition manifested as rickets. Note the bowed legs and knees
Right wrist of a patient with vitamin D deficient rickets before treatment. His right wrist x-ray showed sclerotic and widened end plates of the radius and ulna (arrows)
Right wrist of a patient with vitamin D deficient rickets after treatment (arrows)
Bony changes (arrows) before (bottom panels) and after (top panel) treatment of rickets

Citations

Key Articles

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 495: vitamin D: screening and supplementation during pregnancy. Jul 2011 [internet publication].[Full Text]
Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415.[Abstract][Full Text]

Referenced Articles

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27. Drezner MK. Osteomalacia and rickets. In: Goldman L, Ausiello D, eds. Cecil textbook of medicine, 22nd ed. Philadelphia, PA: Saunders Publishing; 2004:1555-62.
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33. Rothenbuhler A, Esterle L, Gueorguieva I, et al. Two-year recombinant human growth hormone (rhGH) treatment is more effective in pre-pubertal compared to pubertal short children with X-linked hypophosphatemic rickets (XLHR). Growth Horm IGF Res. 2017 Oct;36:11-15.[Abstract]
34. Živičnjak M, Schnabel D, Staude H, et al. Three-year growth hormone treatment in short children with X-linked hypophosphatemic rickets: effects on linear growth and body disproportion. J Clin Endocrinol Metab. 2011 Dec;96(12):E2097-105.[Abstract][Full Text]
35. Meyerhoff N, Haffner D, Staude H, et al. Effects of growth hormone treatment on adult height in severely short children with X-linked hypophosphatemic rickets. Pediatr Nephrol. 2018 Mar;33(3):447-56.[Abstract]
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37. Liu ES, Carpenter TO, Gundberg CM, et al. Calcitonin administration in X-linked hypophosphatemia. N Engl J Med. 2011 Apr 28;364(17):1678-80.[Abstract]
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