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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Rickets Causes

Rickets, fully termed as nutritional vitamin D deficiency rickets, is a chronic systemic nutritional disease characterized by epiphyseal lesions, caused by insufficient vitamin D in children, leading to disordered calcium and phosphate metabolism. The main causes of the disease include insufficient perinatal vitamin D, particularly during the prenatal and postnatal periods, as well as factors like severe maternal malnutrition, liver and kidney diseases, chronic diarrhea, prematurity, and having twins, which may lead to inadequate levels of vitamin D storage in the body. Additionally, insufficient sunlight exposure, such as children spending prolonged periods indoors, blocks sunlight, as ultraviolet rays cannot pass through glass. Ultraviolet light aids in the synthesis of endogenous vitamin D; lack of exposure can also reduce vitamin D levels. Another factor is rapid growth rates, and fourthly, insufficient dietary supplementation of vitamin D along with some diseases that affect the absorption of vitamin D, like gastrointestinal or liver and biliary diseases.

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Is rickets easy to treat?

Rickets is primarily a nutritional disease caused by insufficient levels of vitamin D leading to disturbances in calcium and phosphate metabolism, resulting in abnormal bone development. The most common type is nutritional vitamin D-deficiency rickets. This type of disease is self-limiting and thus relatively easy to treat. It requires early detection and proactive intervention. Early measures include encouraging children to engage in outdoor activities and supplementing with appropriate doses of vitamin D, which can effectively treat rickets. However, there are also special causes of vitamin D deficiency such as significant anomalies in liver or kidney function and certain genetic diseases that severely impair vitamin D absorption. When vitamin D treatment is ineffective, it may be due to other special causes. Treatment of rickets under these circumstances can be more challenging, and genetic diseases may respond poorly to treatment.

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How is rickets diagnosed?

Rickets is a chronic nutritional disease caused by a deficiency in vitamin D, which leads to a disruption in calcium and phosphorus metabolism, resulting in abnormal bone development. Typically, the initial symptoms of rickets are most commonly seen 2-3 months after birth. At this stage, affected children often show neurological symptoms such as excessive sweating unrelated to the season, irritability, particularly in infants under three months old who can become easily agitated, and exhibit straining as if constipated, but these are not specific symptoms of rickets. Early diagnosis generally requires specific tests such as blood biochemistry to check the levels of 125 dihydroxy vitamin D3, as well as calcium and phosphorus levels in the blood, and to see if there is any change in serum alkaline phosphatase. The active phase is mainly characterized by skeletal changes, such as early signs of enlarged fontanelles or delayed closure, late teething, and sometimes a softening of the skull resembling a ping-pong ball, gradually leading to a square skull. Subsequently, changes like pigeon chest or noticeable deformities in the lower limbs such as X-shaped legs, O-shaped legs, or K-shaped legs may appear. Sometimes, there may also be curvature of the spine, with occasional scoliosis. These obvious skeletal changes make the condition more recognizable, though the initial presentations are not very typical, necessitating related biochemical blood tests.

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Can rickets be cured?

Can rickets be cured? Rickets, also known as nutritional vitamin D deficiency rickets, is primarily caused by insufficient levels of vitamin D in the body leading to disorders in calcium and phosphorus metabolism. It is a chronic nutritional disease characterized by skeletal lesions. Typically, it manifests as flawed mineralization of long bones and bone tissue at the growth plates. Vitamin D deficiency rickets is a self-limiting disease that can generally be cured if children have sufficient outdoor activities and adequate exposure to sunlight. Adequate sunlight exposure and physiological doses of vitamin D can treat rickets. Therefore, it is usually recommended that children supplement with 400 units of vitamin D starting about two weeks after birth to prevent and treat rickets. However, if the child is in a later stage and shows obvious skeletal deformities, corrective treatment may be necessary. In severe cases of rickets where intracranial lesions occur, it might affect the child's vital signs and, in serious cases, could even lead to the child's death. Therefore, it is advised that children get plenty of sunlight, routinely supplement with vitamin D, and have regular pediatric check-ups to assess their condition.

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How to diagnose rickets?

Rickets is caused by a deficiency of vitamin D, which leads to abnormal calcium and phosphorus metabolism, and thus abnormal bone development. Generally, rickets requires biochemical blood tests and vitamin D level assessments, followed by skeletal X-ray examinations. However, some cases of rickets are caused by other special reasons, such as abnormalities in liver and kidney functions, and there may also be congenital genetic diseases. Therefore, rickets also requires further related examinations, such as liver function tests, kidney function tests, and parathyroid hormone tests, and even some genetic level examinations might be conducted.