Difference between revisions of "Rickets"

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Revision as of 06:17, 15 January 2017

Background

  • Rickets is a bone disorder characterized by soft, weak, and deformed bones
  • Origin of the word 'rickets' is from the word 'wrickken', to twist
  • The predominant cause is a Vitamin D deficiency, but also inadequate calcium and impaired metabolism of vitamin D may also lead to rickets
  • Rickets is one of the most frequent childhood disease in many developing countries
    • Severe malnutrition from famine or starvation in early childhood
  • Vitamin D is important because it helps in the absorption of calcium and phosphate, minerals responsible for the strength and hardness of bones
  • This disease occurs in children (term used for adults is Osteomalacia
  • Risk factors for Vitamin D deficiency in infants include:
    • Exclusive breastfed infants without vitamin D supplementation
    • Dark skin pigmentation
    • Maternal Vitamin D deficiency
      • In utero, 25-hydroxyvitamin D passes through the placenta to the infant

Types of Rickets

  • Hereditary rickets is an inherited form of the disease
    • Kidneys are unable to retain phosphate
  • Nutritional rickets
  • Vitamin D Resistant Rickets
  • Vitamin D Dependant Rickets
  • Congenital Rickets

Clinical Features

  • Peak incidence between 3 and 18 months of age
  • Enlarged and soft skull (Craniotabes)
  • Enlarged joints of long bones
  • Enlarged joints of the rib cage (aka "rickety rosary"
  • Double malleoli sign due to metaphyseal hyperplasia
  • Widening of wrist due to metaphyseal cartilage hyperplasia
  • Curvature of the spine and femurs
    • Bowed legs in toddlers (Genu varum)
    • Knock-knees in older children (Genu valgum)
  • Generalized muscle weakness
  • Bony pain or tenderness
  • Dental problems
  • Growth disturbance
  • Hypocalcemia
    • Tetany

Differential Diagnosis

Evaluation

Management

  • Prevention key:
    • For healthy infants, children, and adolescents recommend a vitamin D intake of at least 400 IU/day

Disposition

See Also

External Links

References