Vitamin D plays a major role in bone health as it controls absorption and release of calcium and phosphate from the bone. When the body is deficient in vitamin D, certain hormones are released and stimulate the release of calcium and phosphate from the bones. That leads to weakening and softening of bones.
Vitamin D may be absorbed from food, or can be produced by the skin when it is exposed to sunlight. People who spend a lot of time indoors, live in climates with only a few sunny days, or who have dark skin may not produce enough vitamin D, and are at risk for a vitamin D deficiency. Because vitamin D is fat-soluble, malabsorption disorders involving reduced digestion of fats will decrease vitamin D levels absorbed by the body. Other individuals that are at risk for vitamin D deficiency, and thus rickets, are vegetarians, people who do not consume dairy products due to milk allergy or lactose intolerance, or breast-fed babies who do not receive a vitamin D supplementation of 200 IU daily during the first 2 months of life.
Occasionally rickets occurs in children who have certain medical problems such as liver or kidney disorders. Symptoms of rickets include bone pain and skeletal deformities such as bowed legs, pigeon chest, bumps on the chest, deformed skull, spine, or pelvis deformities, increased tendency to fractures, and dental problems. Children with rickets may have delayed formation of teeth, tooth malformation, and/or increased tendency to cavities. Some children with rickets may experience decreased muscle tone, weakness, and grow slower than their peers.
The diagnosis of rickets is made upon a physical exam, and confirmed by blood tests and X-rays. Treatment goals are to relieve symptoms and correct the cause of the condition.
Rickets in the United Sates is rare, although vitamin D deficiency seems to be on the rise. A recent study of urban children from Children's Hospital in Boston, Massachusetts, reported the prevalence of vitamin D deficiency among infants and toddlers to be 12.1%. A lot of people think that rickets is a disease of poor countries, but we do see it the United States. The most common cause of rickets is infants and children not receiving enough calcium in their diet.
For example, the American Academy of Pediatrics (AAP) recommends that all breast-fed infants receive 200 IU of vitamin D drops daily, because breast milk is deficient in vitamin D. One study of breast fed infants revealed that only 15% received the supplement. Therefore, the majority of breast-fed infants are at risk for vitamin D deficiency and rickets.
In addition, we are seeing changing trends in beverage consumption among children in the United States. In the past, milk was the main beverage of choice for growing children. These days, juice and pop seem to be the prevailing choices for children. Since soft drinks do not contain vitamin D, their increased consumption displaces milk, and puts children at risk for vitamin D deficiency and rickets. Prevention is the best medicine, so have your children drink milk daily to assure adequate intake of vitamin D. If you are breast-feeding your infant, talk to your health care provider about vitamin D supplementation.
