Rickets is a disease that affects your bones. It can develop when your body doesn’t have enough vitamin D, calcium or phosphate. The condition primarily affects very young children during periods of fast growth. However, it can also affect adolescents.
Rickets due to vitamin D deficiency is preventable by getting enough vitamin D in your diet and having sun exposure. The condition is most common in the Middle East, Asia and Africa, but cases occur in developed nations as well.
Thankfully, rickets is usually preventable by getting sunshine and enough vitamin D in your diet. There are also other natural, helpful tips for preventing vitamin D deficiency and steps you can take to manage low vitamin D.
What Is Rickets?
Rickets is a bone disorder caused by lack of vitamin D, calcium or phosphate in the body.
Low vitamin D in the body makes it harder for your body to control calcium and phosphate levels. Over time, if you don’t have enough of those minerals in your blood, the body starts to take calcium and phosphate from the bones. This softens and weakens the bones. It can cause growth problems, pain, broken bones and deformities such as bowed legs or scoliosis.
The condition is most common in young children who are growing quickly and don’t have enough vitamin D to keep up with their needs. This creates problems with bone growth, and the symptoms of vitamin D deficiency become noticeable.
Rickets in adults is often called osteomalacia. Rickets and osteomalacia both cause the bones to leach calcium and phosphate due to vitamin D deficiency. This in turn causes the bone structure to soften. Since adults are done growing, they don’t usually have the same issues with stunting and bone deformity, but they often experience bone pain and easy breaks as a result of the condition.
Signs & Symptoms
Rickets symptoms often develop slowly and get worse over time, the longer your body is without the nutrients it needs.
- Bone pain or tenderness, especially in the arms, legs, spine or pelvis
- Weakness that gets worse over time
- Loss of muscle strength
- Growth problems and short stature
- Cramps in the muscles
- Dental problems, such as delayed tooth growth, problems with tooth structure, holes in the tooth enamel or an increase in cavities
- Bones that break easily
- Skeletal deformities such as a large forehead or oddly shaped skull, bowed legs, knock knees, curved spine (scoliosis or kyphosis), pelvic deformities, pigeon chest (breastbone sticks out), thick wrists and ankles, wide elbows or a bumpy ribcage
- Large abdomen
Symptoms of vitamin D deficiency or rickets should be addressed as soon as possible, particularly during childhood. Without prompt treatment, rickets can cause permanent short stature and bone deformities.
Causes & Risk Factors
The most common rickets cause is vitamin D deficiency. In most cases, the deficiency is caused by a diet low in vitamin D or too little time in the sun.
In rare cases, rickets is hereditary, or people may have a problem absorbing vitamin D, calcium or phosphate.
Risk factors for rickets include:
- Young age: Between six months and three years of age, children are at a high risk.
- Diets low in fish, eggs and dairy products: This is most common with vegetarian and vegan diets and people with lactose intolerance.
- Dark skin: Children of Middle Eastern, African and Pacific Islander descent are most likely to develop rickets since their skin makes less vitamin D in response to sunlight.
- Living in an area with little exposure to the sun or living a lifestyle where you are indoors during daylight hours: The less your skin is exposed to the sun (without sunscreen), the less vitamin D your body makes.
- Health conditions that interfere with the body’s absorption of nutrients such as vitamin D or phosphate: These include cystic fibrosis, inflammatory bowel disease, celiac disease and kidney problems, including kidney failure.
- Exclusively breastfed infants: In most cases, breast milk doesn’t offer enough vitamin D to prevent rickets in babies, especially if the mother and baby do not spend time in the sun.
- Vitamin D deficiency in a mother during pregnancy, or premature birth: Both of these scenarios increase the baby’s risk of rickets.
Without treatment, rickets can cause serious complications. These include:
- Stunted growth
- Curved legs or spine
- Other bone deformities, such as bumps
- Long-term dental problems
- Long-term bone pain
- Broken bones even without reason
Diagnosis & Conventional Treatment
Rickets is usually diagnosed with the following checks and tests:
- A physical exam
- A health history and questions about your diet and habits
- X-rays to check the bones for curves, calcium loss and changes in the shape of bones
- Blood tests to check for low levels of phosphorus and calcium, as well as high levels of alkaline phosphatase
- Bone biopsies (rarely) to check the actual bone for rickets
- Urine tests for calcium
Rickets treatment depends on the cause. If your case is caused by a low vitamin D diet or lack of sun, you can expect a physician or nutritionist to carefully guide your dietary calcium and vitamin D intake, adjusting as needed. You may be told to take over-the-counter dietary supplements. Treatment usually lasts a few months, but many children start improving within a few weeks (or less) of getting enough vitamin D. You may also be told to get daily mid-day sun exposure without using sunscreen, although this is not officially recommended by the American Academy of Pediatrics due to skin cancer risk.
If your rickets is caused by a metabolic problem, you may need a prescription-strength vitamin D, calcium or phosphorus supplement.
Depending on your current bone symptoms, you may also need bracing or positioning tools to help lessen or avoid deformities. In extreme cases, bone deformities may require surgery.
Once rickets is corrected, you should continue regular dietary vitamin D and, if recommended by your doctor, moderate sun exposure (15 minutes per day in bright sun) to avoid low vitamin D in the future. If you have hereditary rickets or rickets caused by absorption or metabolic problems, you may require lifelong supplements or other treatments.
5 Natural Ways to Improve Vitamin D Deficiency
Most people with rickets are children who will require the guidance of their parent and healthcare provider to improve their condition. Thankfully, most cases of rickets can be corrected with food and sun.
- Get some sun
- Enjoy more dairy
- Incorporate more fish into your diet
- Explore vegan sources of calcium and vitamin D
- Ask about regular supplement use
1. Get some sun
There are many health benefits from being outdoors. And in the case of rickets, spending time in the sun can help your body regain healthy vitamin D levels and maintain them (if your condition is caused by a deficiency). While there is some debate about how much sun exposure to encourage without sunscreen, most people can get enough vitamin D production to maintain healthy levels by having exposure during the brightest part of the day (11 a.m. to 3 p.m.) for about 15 minutes, two or three times a week from May through October (at about 40 degrees latitude). Your arms, face and legs should be exposed without sunscreen. If your skin is dark, you may need more time; if you are fair-skinned, you need a little less. The important thing is just to avoid sunburn. There are many benefits to this type of moderate sun exposure:
- As long as you aren’t getting burned, sun exposure actually may have a protective effect against skin cancer.
- Sun exposure helps your body make vitamin D, a hormone that controls what your body does with calcium and phosphorus, among other things. This is how sun exposure helps your body recover from and avoid rickets.
- People with higher levels of sun exposure and vitamin D in their bodies are less likely to develop colon cancer and breast cancer.
- People with multiple sclerosis, prostate cancer and non-Hodgkin’s lymphoma benefit from sun exposure independently from vitamin D levels.
Remember if you expect to be in the sun longer, you currently have a sunburn or you will be in intense sun and have not been acclimated to sun exposure, it is still important to use sunscreen.
2. Pour a glass of dairy milk
The addition of vitamin D to cow’s milk early in the 1900s was responsible for the near eradication of rickets in the United States. Most cow’s milk sold in the U.S. is still fortified with 400 IU of vitamin D per quart. Children who drink only non-cow’s milk beverages, such as nut, soy, rice or coconut milk, are more likely to develop a vitamin D deficiency.
If you do not need to avoid dairy for health reasons or dietary beliefs, consider incorporating dairy milk into your diet on a daily basis. This can increase your levels of vitamin D with little effort. Keep in mind that ice cream, butter, yogurt and other dairy products are usually not fortified with vitamin D.
Overall, some of the top food sources of vitamin D are fish, dairy milk (fortified), beef liver, eggs and caviar. Some of the top dietary sources of calcium include sardines, yogurt, milk and cheese. Top phosphorus sources are also proteins such as meat, as well as breads and cereals made from refined grains. Getting some of these top dietary sources for vitamin D, calcium and phosphorus in your daily diet can help you avoid rickets in most cases.
3. Incorporate more fish into your diet
Fish naturally contain vitamin D3, which our bodies can take up and use effectively. Typically, eating oily fish or taking fish oil supplements are considered very simple ways to get more vitamin D in your diet. Speak to your healthcare provider about the ideal dose of fish oil or weekly fish intake for children.
- A study looking at the amount of vitamin D in fish samples and how much remained after baking or frying found that wild-caught salmon, Ahi tuna and farmed trout were the top sources of vitamin D. They retained nearly all of the vitamin D after baking but only about half of it when fried.
- In a small study of patients with Crohn’s disease, fish oil supplementation helped improve their vitamin D levels as well as their quality of life.
- Cod-liver oil has historically been the primary treatment for rickets, especially in areas with little sun. It can effectively begin to heal symptoms in many people.
4. Explore vegan sources of calcium and vitamin D
If you must avoid dairy, meat and fish due to dietary constraints, intolerance or food allergies, don’t distress — you can still get the nutrients you need from vitamin D foods!
- Top vegan options for vitamin D include:
- Fortified cereal
- Fortified orange juice
- Mushrooms exposed to UV light
- Top vegan options for calcium include:
- Kale (uncooked)
- Okra (uncooked)
- Bok choy
- Broccoli (uncooked) or broccoli rabe
- Collard greens
- White beans
- Acorn squash
5. Ask about regular supplement use
The American Academy of Pediatrics recommends healthy infants, children and adolescents get at least 400 IU/day of vitamin D. To do so, they recommend:
- Breastfed infants should get vitamin D drops to supplement the breast milk, 400 IU/day, until they transition to at least one liter per day of fortified formula or cow’s milk (at 12 months).
- Infants who are not breastfed and other young children who do not drink a liter per day of fortified milk should either receive a vitamin D supplement of 400 IU/day or get other dietary sources of the vitamin.
- Adolescents should take a vitamin D supplement of 400 IU/day unless they drink four 8-ounce servings of fortified milk each day.
- Children who have rickets or a condition that puts them at risk for low vitamin D, such as kids taking anti-seizure medications or those who have problems absorbing nutrients, may need higher doses of vitamin D. In these cases, your child may need blood testing every three to six months to check vitamin D levels and adjust the daily supplement as needed.
The National Institutes of Health have additional guidance that varies by age and life situation. The total IU per day can come from food, supplements and sun exposure but should reach at these levels for most people:
- Babies up to one year of age should get 400 IU per day.
- Children ages one to 13 should get 600 IU per day.
- People ages 14–70 should get 600 IU per day.
- Adults 71 and older should get 800 IU per day.
- Pregnant and breastfeeding women should get 600 IU per day.
Knowing what causes rickets also teaches us how to prevent rickets. The vitamin D deficiency at the root of most people’s rickets or osteomalacia diagnosis is a result of too little sun and too little dietary intake of vitamin D.
In these cases, prevention of rickets involves achieving and maintaining a healthy daily dose of sun or dietary vitamin D. This enables your body to make the hormone that works with calcium and phosphorus and can prevent the minerals leaching from your bones. In most cases, people can prevent rickets through adequate sunshine and the levels of daily vitamin D mentioned above.
For people with metabolic conditions or hereditary issues resulting in vitamin D deficiency, prevention may require extra supplementation or even a vitamin D pill that is prescription-strength. You may also need to take medications to control your related health condition, such as Crohn’s disease, to help your body function as well as possible and avoid rickets. People at risk for rickets and vitamin D deficiency caused by something other than poor diet or too little sun may need long-term monitoring by a healthcare professional. This can help clue you in to your levels and the right vitamin D doses to keep your bones healthy.
- It is possible to get too much vitamin D. Before beginning a supplement to treat or prevent rickets, talk to a healthcare professional or pharmacist. Although vitamin D toxicity is rare, it can cause serious health problems. Toxicity is most likely to occur if you take more than 10,000 IU/day (especially 40,000 IU/day or higher) on a regular basis.
- Although sunshine is important and an easy way to get vitamin D, you should not put yourself at risk of sunburn. Protect your skin when you will be in intense sun or outside for long periods of time. If you burn easily, aim to get your required vitamin D levels through diet or supplements.
- Do not attempt to self-diagnose rickets or osteomalacia. Bone pain, broken bones, weakness and other symptoms of rickets can also be signs of other conditions. In addition, rickets may require more than just sunshine and vitamin D to correct. Always seek care from a health professional before beginning treatment.
- Without proper treatment, rickets can cause seizures and other serious problems. If the condition is not treated quickly, bone and dental problems, pain and deformity can be permanent. Always seek care promptly if you believe you or your child has a vitamin D deficiency.
Rickets Key Points
- Rickets is a skeletal disorder caused by low vitamin D, calcium or phosphorus.
- In most cases, the deficiency is caused by a lack of sun exposure and poor diet.
- It is rare in developed nations but is on the rise, likely due to the amount of time spent indoors and the increasing popularity of non-dairy drinks.
- Key symptoms of rickets include weak and soft bones that may break easily or cause pain. Muscles may also ache and skeletal deformities, such as a curved spine, protruding chest, bowlegs or thick wrists and ankles may develop.
- With proper treatment, signs and symptoms of rickets can start to resolve within a week. Some people may require more than just a dietary supplement or sunshine. Skeletal deformities may need surgery or bracing.
In general, however, rickets is a condition for which conventional and natural therapies are one and the same. Most cases can be resolved with sunshine and sufficient vitamin D in the diet or via supplements. In addition, there are ways to naturally improve low vitamin D levels and prevent rickets from returning:
- Get some sun
- Enjoy more dairy
- Incorporate more fish into your diet
- Explore vegan sources of calcium and vitamin D
- Ask about regular supplement use
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