Rickets

Rickets

Infobox Disease
Name = Rickets
ICD10 = ICD10|E|55| |e|50
ICD9 = ICD9|268


Caption = A family with rickets. Paris, 1900.
DiseasesDB = 9351
eMedicineSubj = ped
eMedicineTopic = 2014
MedlinePlus = 000344
MeshName = Rickets
MeshNumber = D012279

Rickets is a 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 a 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.
Osteomalacia is the term used to describe a similar condition occurring in adults, generally due to a deficiency of vitamin D. [ [http://www.nlm.nih.gov/medlineplus/ency/article/000376.htm MedlinePlus Medical Encyclopedia: Osteomalacia ] ] The origin of the word "rickets" is probably from the Old English dialect word 'wrickken', to twist. The Greek derived word "rachitis" (meaning "inflammation of the spine") was later adopted as the scientific term for rickets, due chiefly to the words' similarity in sound.

Epidemiology

Those at higher risk for developing rickets include:
*Breast-fed infants whose mothers are not exposed to sunlight
*Breast-fed infants who are not exposed to sunlight
*Individuals not consuming fortified milk, such as those who are lactose intolerant

Individuals with red hair have been speculated to have a decreased risk for rickets due to their greater production of vitamin D in sunlight.

Etiology

Vitamin D is required for proper calcium absorption from the gut. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in hypocalcemia, leading to skeletal and dental deformities and neuromuscular symptoms, e.g. hyperexcitability.

A rare X-linked dominant form exists called Vitamin D resistant rickets.

Presentation

Signs and symptoms of rickets include:
*Bone pain or tenderness
*dental problems
*muscle weakness (rickety myopathy or "floppy baby syndrome")
*increased tendency for fractures (easily broken bones), especially greenstick fractures
*Skeletal deformity
**Toddlers: Bowed legs (genu varum)
**Older children: Knock-knees (genu valgum) or "windswept knees"
**Cranial, spinal, and pelvic deformities
*Growth disturbance
*Hypocalcemia (low level of calcium in the blood), and
*Tetany (uncontrolled muscle spasms all over the body).
*Craniotabes (soft skull)
*Costochondral swelling (aka "rickety rosary" or "rachitic rosary")
*Harrison's groove
*Double malleoli sign due to metaphyseal hyperplasiaAn X-ray or radiograph of an advanced sufferer from rickets tends to present in a classic way: bow legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life if not treated.

Long-term consequences include permanent bends or disfiguration of the long bones, and a curved back.

Diagnosis

A doctor may diagnose rickets by:

*Blood tests:
**Serum calcium may show low levels of calcium, serum phosphorus may be low, and serum alkaline phosphatase may be high.
*Arterial blood gases may reveal metabolic acidosis
*X-rays of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones.
*Bone biopsy is rarely performed but will confirm rickets.

Treatment and prevention

The treatment and prevention of rickets is known as " [http://dictionary.reference.com/browse/antirachitic antirachitic] ".

Diet and sunlight

Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet light (sunshine), cod liver oil, halibut-liver oil, and viosterol are all sources of vitamin D.

A sufficient amount of ultraviolet in sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned babies need to be exposed longer to the ultraviolet rays. The replacement of vitamin D has been proven to correct rickets using these methods of [http://pediatrics.aappublications.org/cgi/content/full/112/2/e132 ultraviolet light therapy] and medicine.

Recommendations are for 200 international units (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance.

upplementation

Sufficient vitamin D levels can also be achieved through dietary supplementation. Vitamin D3 (cholecalciferol) is the preferred form since it is more readily absorbed than vitamin D2. Most dermatologists recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of skin cancer associated with sun exposure. Note that in July in New York City at noon with the sun out, a white male in tee shirt and shorts will produce 20,000 I.U Vitamin D from 20 minutes of non-sunscreen sun exposure.Fact|date=August 2008

According to the American Academy of Pediatrics (AAP), infants who are breast-fed may not get enough vitamin D from breast milk alone. For this reason, the AAP recommends that infants who are exclusively breast-fed receive daily supplements of vitamin D from age 2 months until they start drinking at least 17 ounces of vitamin D-fortified milk or formula a day. [cite journal |author=Gartner LM, Greer FR |title=Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake |journal=Pediatrics |volume=111 |issue=4 Pt 1 |pages=908–10 |year=2003 |month=April |pmid=12671133 |doi= |url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/908] This requirement for supplemental vitamin D is not a defect in the evolution of human breastmilk but is instead a result of the modern-day infant's decreased exposure to sunlight.

References

External links

* [http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/908 AAP Recommendations on Vitamin D Supplementation]
* [http://courses.washington.edu/bonephys/hypercalU/opmal2.html Dr. Susan Ott's website on osteomalacia]
* [http://www.healthvitaminsguide.com/deficiencies/rickets.htm Rickets - Symptoms, Causes, Treatment]
* [http://dictionary.reference.com/search?q=osteomalacia Dictionary.com - Osteomalacia]
* [http://www.fluoridealert.org/health/bone/fluorosis/osteomalacia.html Fluoride & Osteomalacia]
* [http://www.beyonddiscovery.org/content/view.txt.asp?a=414 History of Vitamin D and the battle against Rickets]
*


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Look at other dictionaries:

  • rickets — disease caused by vitamin D deficiency, 1630s, of uncertain origin. Originally a local name for the disease in Dorset and Somerset, England. Some derive it from a Dorset word, rucket to breathe with difficulty, but the sense connection is… …   Etymology dictionary

  • rickets — ► NOUN (treated as sing. or pl. ) ▪ a disease of children caused by vitamin D deficiency, characterized by softening and distortion of the bones. ORIGIN perhaps an alteration of Greek rhakhitis rickets …   English terms dictionary

  • Rickets — Rick ets, n. pl. [Of uncertain origin; but cf. AS. wrigian to bend, D. wrikken to shake, E. wriggle.] (Med.) A disease which affects children, and which is characterized by a bulky head, crooked spine and limbs, depressed ribs, enlarged and… …   The Collaborative International Dictionary of English

  • rickets — rickets. См. гиповитаминоз D. (Источник: «Англо русский толковый словарь генетических терминов». Арефьев В.А., Лисовенко Л.А., Москва: Изд во ВНИРО, 1995 г.) …   Молекулярная биология и генетика. Толковый словарь.

  • rickets — [rik′its] n. [altered < ? Gr rhachitis,RACHITIS] a disease of the skeletal system, chiefly of children, resulting from absence of the normal effect of vitamin D in depositing calcium salts in the bone, and characterized by a softening and,… …   English World dictionary

  • Rickets — A disease of infants and children that disturbs normal bone formation (ossification). Rickets is a failure to mineralize bone. This softens bone (producing osteomalacia) and permits marked bending and distortion of bones. Up through the first… …   Medical dictionary

  • rickets — /rik its/, n. Pathol. a disease of childhood, characterized by softening of the bones as a result of inadequate intake of vitamin D and insufficient exposure to sunlight, also associated with impaired calcium and phosphorus metabolism. [1635 45;… …   Universalium

  • rickets — n. a disease of childhood in which the bones do not harden due to a deficiency of vitamin D. Without vitamin D, not enough calcium salts are deposited in the bones to make them rigid: consequently they become soft and malformed. This is… …   The new mediacal dictionary

  • rickets — [[t]rɪ̱kɪts[/t]] N UNCOUNT Rickets is a disease that children can get when their food does not contain enough Vitamin D. It makes their bones soft and causes their liver and spleen to become too large …   English dictionary

  • Rickets, celiac — Rickets caused by failure of the intestines to absorb calcium and fat from foods …   Medical dictionary

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