Rickets / Osteomalacia
Rickets / Osteomalacia
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Rickets is the 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 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. Infants who are born prematurely or who have dark skin, and babies who are breast-fed by poorly nourished mothers or who are unexposed to the sun, are all at higher risk for developing rickets.
Osteomalacia is the term used to describe a similar condition occurring in adults, generally due to a deficiency of Vitamin D. The origin of the word "rickets" is unknown. The Greek-derived word "rachitis" (meaning "inflammation of the spine") was later adapted as the scientific term for rickets, due chiefly to the words' similarity in sound.
Vitamin D is needed in absorption of calcium and phosphorus from the intestines. Calcium and phosphorous is needed for development of healthy bones and teeth. The principal function of Vitamin D is to maintain serum calcium and phosphorus concentration within the range that supports neuromuscular function, bone calcification and other cellular processes.
Vitamin D is also capable of influcing differentiation in some cancer cells, such as skin, bone, and breast cancer cells.
Indeed, adequate Vitamin D status hs been linkedd to reduced risk of developing breast,colonm and prostrate cancers.
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Without adequate calcium and phosphorus in the blodd available for depositionin the bone, the skeleton fails to mineralize properly and bones weeaken and bow under pressure. When these effects occur in a child, the ddisese is called rickets.
Causes of osteomalacia
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Problems such as spinal deformities, bow legs, knock-knees, a deformed chest, changes in the skull causing a distinctive "square headed" appearance may persist into adult life if not treated
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Symptoms of osteomalacia
- Fractures in the hip, spine and other bones
- Diffuse bone pain, especially in the hips
- Muscle weakness
- Symptoms associated with low calcium
- Numbness around the mouth
- Numbness of extremities
- Spasms of hands or feet
- Use of supplements :vitamin D and calcium can be given as dietary supplements
- Sunshine exposure: there is however, a genuine risk of skin cancer with excessive amount of unprotected sunshine exposure. Use of special sunscreens which filter the harmful rays whilst allowing for good rays to reach your skin is a good option. Ideally, sun exposure in the tropics is best done when the sun is not intense - the so-called 'morning and evening sun' as opposed to midday sun.
- Diet rich in vitamin D and calcium
- Treat any other underlying factor like kidney disease
- For bone deformities such as bowlegs and some spinal deformities, braces may be used but in severe cases, surgery may be required.
Sources of vitamin D
- Sunlight: Your skin produces vitamin D when it's exposed to sunlight. Some people may not receive enough sun exposure to generate sufficient active Vitamin D for the body's needs they need to pay attention to dietary sources. Few foods contain appreciable amounts of vitamin D,
- Dietary: Foods rich in vitamin D include fatty fish (e.g slamon and srdines), fortified milk and some fortified brekfast cereals. Although eggs, butter, liver and few brands of margarine contain some vitamin D, large servings must be eaten to obtain an appreciabel amount of vitamin; thus these foods are not considered significant sources.
Getting enough calcium
Calcium and phosphorus consumption are also important for bone formation in childhood. Breast milk is a good source of calcium, as are most commercially available formulas.
Recommended daily intake of calcium is as follows (serving sizes vary with age):
Recommended daily intake of calcium
Life Stage | Age | Males (mg/day) | Females (mg/day) |
Infants | 0-6 months | 210 | 210 |
Infants | 7-12 months | 270 | 270 |
Children | 1-3 years | 500 | 500 |
Children | 4-8 years | 800 | 800 |
Children | 9-13 years | 1,300 | 1,300 |
Adolescents | 14-18 years | 1,300 | 1,300 |
Adults | 19-50 years | 1,000 | 1,000 |
Adults | 51 years and older | 1,200 | 1,200 |
Pregnancy | 18 years and younger | - | 1,300 |
Pregnancy | 19 years and older | - | 1,000 |
Breast-feeding | 18 years and younger | - | 1,300 |
Breast-feeding | 19 years and older | - | 1,000 |
- 1 to 3 years of age. 500 milligrams (mg) (two servings of dairy products a day)
- 4 to 8 years of age. 800 mg (two to three servings of dairy products a day)
- 9 to 18 years of age. 1,300 mg (four servings of dairy products a day)
- 19 to 50 years of age. 1,000 mg a day (three servings of dairy products a day)
- Older than 50. 1,200 mg a day (nearly four servings of dairy products daily)
Milk and dairy products are common sources of calcium. Other sources of calcium include leafy green vegetables (for example, spinach), fortified orange juices, fortified breakfast cereals and calcium supplements.
Food | Serving | Calcium (mg) | Servings needed to equal the absorbable calcium in 8 oz of milk |
Milk | 8 ounces | 300 | 1.0 |
Yogurt | 8 ounces | 300 | 1.0 |
Cheddar cheese | 1.5 ounces | 303 | 1.0 |
Pinto beans | 1/2 cup, cooked | 45 | 8.1 |
Red beans | 1/2 cup, cooked | 41 | 9.7 |
White beans | 1/2 cup, cooked | 113 | 3.9 |
Tofu, calcium set | 1/2 cup | 258 | 1.2 |
Bok choy | 1/2 cup, cooked | 79 | 2.3 |
Kale | 1/2 cup, cooked | 61 | 3.2 |
Chinese cabbage | 1/2 cup, cooked | 239 | 1.0 |
Broccoli | 1/2 cup, cooked | 35 | 4.5 |
Spinach | 1/2 cup, cooked | 115 | 16.3 |
Rhubarb | 1/2 cup, cooked | 174 | 9.5 |
Fruit punch with calcium citrate malate |
8 ounces | 300 | 0.62 |
Recommended daily intake of Vitamin D
Life Stage | Age | Males mcg/day (IU/day) |
Females mcg/day (IU/day) |
Infants | 0-6 months | 5 mcg (200 IU) | 5 mcg (200 IU) |
Infants | 7-12 months | 5 mcg (200 IU) | 5 mcg (200 IU) |
Children | 1-3 years | 5 mcg (200 IU) | 5 mcg (200 IU) |
Children | 4-8 years | 5 mcg (200 IU) | 5 mcg (200 IU) |
Children | 9-13 years | 5 mcg (200 IU) | 5 mcg (200 IU) |
Adolescents | 14-18 years | 5 mcg (200 IU) | 5 mcg (200 IU) |
Adults | 19-50 years | 5 mcg (200 IU) | 5 mcg (200 IU) |
Adults | 51-70 years | 10 mcg (400 IU) | 10 mcg (400 IU) |
Adults | 71 years and older | 15 mcg (600 IU) | 15 mcg (600 IU) |
Pregnancy | all ages | - | 5 mcg (200 IU) |
Breast-feeding | all ages | - | 5 mcg (200 IU) |
Vitamin D rich foods
Food | Serving | Vitamin D (IU) | Vitamin D (mcg) |
Pink salmon, canned | 3 ounces | 530 | 13.3 |
Sardines, canned | 3 ounces | 231 | 5.8 |
Mackerel, canned | 3 ounces | 213 | 5.3 |
Cow's milk, fortified with vitamin D |
8 ounces | 98 | 2.5 |
Soy milk, fortified with vitamin D | 8 ounces | 100 | 2.5 |
Orange juice, fortified with vitamin D |
8 ounces | 100 | 2.5 |
Cereal, fortified | 1 serving (usually 1 cup) |
40-50 | 1.0-1.3 |
Egg yolk | 1 large | 21 | 0.53 |
The majority of non-severe cases of both rickets and osteomalacia respond well to treatment and improvement is seen within 3-6 months.
With adequate treatment and follow up, most individuals lead normal lives.
The main problem encountered is re-occurence mainly due to poor diet issues.
- ADA reports (2001). Position of the American Dietetic Association: Food fortification ad dietary supplements. Journal fo teh Amecican Dietetic Association 101: 115
- Holick MF (1999). Vitamin D. In shils Me and Others (eds): Modern nutrition in Health and disease. 9th ed. Baltimore,Md Williams & Wilkins