BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuRicketsOsteomalacia in children; Vitamin D deficiency; Renal rickets; Hepatic ricketsRickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Causes Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones. This leads to weak and soft bones.Vitamin DVitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's fatty tissue and liver.ImageRead Article Now Book Mark Article Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D production by the skin may occur in people who:Live in climates with little exposure to sunlight Must stay indoors Work indoors during the daylight hoursYou may not get enough vitamin D from your diet if you:Are lactose intolerant (have trouble digesting milk products) Lactose intolerantLactose is a type of sugar found in milk and other dairy products. An enzyme called lactase is needed by the body to digest lactose. Lactose intoler...ImageRead Article Now Book Mark Article DO NOT drink milk products Follow a vegetarian dietInfants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D. This can be a particular problem for darker-skinned children in winter months. This is because there are lower levels of sunlight during these months.Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in the diet is rare in developed countries. Calcium and phosphorous are found in milk and green vegetables.Your genes may increase your risk for rickets. Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis.Renal tubular acidosisProximal renal tubular acidosis is a disease that occurs when the kidneys don't properly remove acids from the blood into the urine. As a result, to...ImageRead Article Now Book Mark Article Disorders that reduce the digestion or absorption of fats will make it more difficult for vitamin D to be absorbed into the body.Sometimes, rickets may occur in children who have disorders of the liver. These children cannot convert vitamin D to its active form.Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth. This is the age when the body needs high levels of calcium and phosphate. Rickets may also be seen in children ages 6 to 24 months. It is uncommon in newborns. Symptoms Symptoms of rickets include:Bone pain or tenderness in the arms, legs, pelvis, and spine Bone pain or tendernessBone pain or tenderness is aching or other discomfort in one or more bones.ImageRead Article Now Book Mark Article Decreased muscle tone (loss of muscle strength) and weakness that gets worse Decreased muscle toneHypotonia means decreased muscle tone.ImageRead Article Now Book Mark Article WeaknessWeakness is reduced strength in one or more muscles.Read Article Now Book Mark Article Dental deformities, including delayed tooth formation, defects in the tooth structure, holes in the enamel, and increased cavities (dental caries) Dental cariesDental cavities are holes (or structural damage) in the teeth.ImageRead Article Now Book Mark Article Impaired growth Impaired growthDelayed growth is poor or abnormally slow height or weight gains in a child younger than age 5. This may just be normal, and the child may outgrow i...ImageRead Article Now Book Mark Article Increased bone fractures Muscle cramps Muscle crampsMuscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...ImageRead Article Now Book Mark Article Short stature (adults less than 5 feet or 1.52 meters tall) Short statureA child who has short stature is much shorter than children who are the same age and sex. Your health care provider will go over your child's growth ...ImageRead Article Now Book Mark Article Skeletal deformities such as an odd-shaped skull, bowlegs, bumps in the ribcage (rachitic rosary), breastbone that is pushed forward (pigeon chest), pelvic deformities, and spine deformities (spine that curves abnormally, including scoliosis or kyphosis)Skeletal deformitiesSkeletal limb abnormalities refers to a variety of bone structure problems in the arms or legs (limbs).Read Article Now Book Mark Article BowlegsBowlegs is a condition in which the knees stay wide apart when a person stands with the feet and ankles together. It is considered normal in childre...Read Article Now Book Mark Article ScoliosisScoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a b...ImageRead Article Now Book Mark Article KyphosisKyphosis is a curving of the spine that causes a bowing or rounding of the back. This leads to a hunchback or slouching posture.ImageRead Article Now Book Mark Article Exams and Tests A physical exam reveals tenderness or pain in the bones, but not in the joints or muscles.The following tests may help diagnose rickets:Arterial blood gases Arterial blood gasesBlood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.ImageRead Article Now Book Mark Article Blood tests (serum calcium) Serum calciumThe calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...ImageRead Article Now Book Mark Article Bone biopsy (rarely done) Bone biopsyA bone lesion biopsy is the removal of a piece of bone or bone marrow for examination.ImageRead Article Now Book Mark Article Bone x-rays Bone x-raysA bone x-ray is an imaging test to look at the bones.ImageRead Article Now Book Mark Article Serum alkaline phosphatase (ALP) Serum alkaline phosphataseAlkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. A blo...ImageRead Article Now Book Mark Article Serum phosphorusSerum phosphorusThe phosphorus blood test measures the amount of phosphate in the blood.ImageRead Article Now Book Mark Article Other tests and procedures include the following:ALP isoenzyme ALP isoenzymeAlkaline phosphatase (ALP) is an enzyme found in many body tissues such as liver, bile ducts, bone, and intestine. There are several different struc...ImageRead Article Now Book Mark Article Calcium (ionized) Calcium (ionized)Ionized calcium is calcium in your blood that is not attached to proteins. It is also called free calcium. All cells need calcium in order to work. ...ImageRead Article Now Book Mark Article Parathyroid hormone (PTH) PTHThe PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...Read Article Now Book Mark Article Urine calciumUrine calciumThis test measures the amount of calcium in the urine. All cells need calcium in order to work. Calcium helps build strong bones and teeth. It is ...ImageRead Article Now Book Mark Article Treatment The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated to prevent the disease from returning.Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish liver and processed milk.Exposure to moderate amounts of sunlight is encouraged. If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed.Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require surgery to correct them. Outlook (Prognosis) The disorder may be corrected by replacing vitamin D and minerals. Laboratory values and x-rays usually improve after about 1 week. Some cases may require large doses of minerals and vitamin D.If rickets is not corrected while the child is still growing, skeletal deformities and short stature may be permanent. If it is corrected while the child is young, skeletal deformities often improve or disappear with time. Possible Complications Possible complications are: Long-term (chronic) skeletal pain ChronicChronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...ImageRead Article Now Book Mark Article Skeletal deformities Skeletal fractures, may occur without cause When to Contact a Medical Professional Contact your child's health care provider if you notice symptoms of rickets. Prevention You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in their diet. Children who have digestive or other disorders may need to take supplements prescribed by the child's provider.Kidney (renal) diseases that may cause poor vitamin D absorption should be treated right away. If you have renal disorders, monitor calcium and phosphorus levels regularly.Renal disordersA renal disorder refers to any disease of the kidneys. Urological disorders are diseases of the kidneys and urinary tract. This includes the kidneys...ImageRead Article Now Book Mark Article Genetic counseling may help people who have a family history of inherited disorders that can cause rickets.Open ReferencesReferencesBhan A, Rao AD, Bhadada SK, Rao SD. Rickets and osteomalacia. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 31.Demay MB, Krane SM. Disorders of mineralization. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 71.Greenbaum LA. Vitamin D deficiency (rickets) and excess. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 64.Weinstein RS. Osteomalacia and rickets. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 231.AllVideoImagesTogX-ray - illustration X-rays are a form of ionizing radiation that can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.X-rayillustrationX-ray - illustration X-rays are a form of ionizing radiation that can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.X-rayillustrationRelated Information Vitamin D(Nutrition)Osteomyelitis(Condition)Malabsorption(Condition)Lactose intolerance(Condition)Proximal renal tubular acidosis(Condition)Chronic kidney disease(Condition)Osteomalacia(Condition)Osteoporosis(Condition)Chronic(Special Topic)Vitamins and Phytonutrients - InDepth(In-Depth)Osteoporosis - InDepth(In-Depth) Review Date: 7/28/2022 Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited. © 1997- All rights reserved. A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.Content is best viewed in IE9 or above, Firefox and Google Chrome browser.
RicketsOsteomalacia in children; Vitamin D deficiency; Renal rickets; Hepatic ricketsRickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones. Causes Vitamin D helps the body control calcium and phosphate levels. If the blood levels of these minerals become too low, the body may produce hormones that cause calcium and phosphate to be released from the bones. This leads to weak and soft bones.Vitamin DVitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's fatty tissue and liver.ImageRead Article Now Book Mark Article Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D production by the skin may occur in people who:Live in climates with little exposure to sunlight Must stay indoors Work indoors during the daylight hoursYou may not get enough vitamin D from your diet if you:Are lactose intolerant (have trouble digesting milk products) Lactose intolerantLactose is a type of sugar found in milk and other dairy products. An enzyme called lactase is needed by the body to digest lactose. Lactose intoler...ImageRead Article Now Book Mark Article DO NOT drink milk products Follow a vegetarian dietInfants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D. This can be a particular problem for darker-skinned children in winter months. This is because there are lower levels of sunlight during these months.Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in the diet is rare in developed countries. Calcium and phosphorous are found in milk and green vegetables.Your genes may increase your risk for rickets. Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis.Renal tubular acidosisProximal renal tubular acidosis is a disease that occurs when the kidneys don't properly remove acids from the blood into the urine. As a result, to...ImageRead Article Now Book Mark Article Disorders that reduce the digestion or absorption of fats will make it more difficult for vitamin D to be absorbed into the body.Sometimes, rickets may occur in children who have disorders of the liver. These children cannot convert vitamin D to its active form.Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth. This is the age when the body needs high levels of calcium and phosphate. Rickets may also be seen in children ages 6 to 24 months. It is uncommon in newborns. Symptoms Symptoms of rickets include:Bone pain or tenderness in the arms, legs, pelvis, and spine Bone pain or tendernessBone pain or tenderness is aching or other discomfort in one or more bones.ImageRead Article Now Book Mark Article Decreased muscle tone (loss of muscle strength) and weakness that gets worse Decreased muscle toneHypotonia means decreased muscle tone.ImageRead Article Now Book Mark Article WeaknessWeakness is reduced strength in one or more muscles.Read Article Now Book Mark Article Dental deformities, including delayed tooth formation, defects in the tooth structure, holes in the enamel, and increased cavities (dental caries) Dental cariesDental cavities are holes (or structural damage) in the teeth.ImageRead Article Now Book Mark Article Impaired growth Impaired growthDelayed growth is poor or abnormally slow height or weight gains in a child younger than age 5. This may just be normal, and the child may outgrow i...ImageRead Article Now Book Mark Article Increased bone fractures Muscle cramps Muscle crampsMuscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...ImageRead Article Now Book Mark Article Short stature (adults less than 5 feet or 1.52 meters tall) Short statureA child who has short stature is much shorter than children who are the same age and sex. Your health care provider will go over your child's growth ...ImageRead Article Now Book Mark Article Skeletal deformities such as an odd-shaped skull, bowlegs, bumps in the ribcage (rachitic rosary), breastbone that is pushed forward (pigeon chest), pelvic deformities, and spine deformities (spine that curves abnormally, including scoliosis or kyphosis)Skeletal deformitiesSkeletal limb abnormalities refers to a variety of bone structure problems in the arms or legs (limbs).Read Article Now Book Mark Article BowlegsBowlegs is a condition in which the knees stay wide apart when a person stands with the feet and ankles together. It is considered normal in childre...Read Article Now Book Mark Article ScoliosisScoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a b...ImageRead Article Now Book Mark Article KyphosisKyphosis is a curving of the spine that causes a bowing or rounding of the back. This leads to a hunchback or slouching posture.ImageRead Article Now Book Mark Article Exams and Tests A physical exam reveals tenderness or pain in the bones, but not in the joints or muscles.The following tests may help diagnose rickets:Arterial blood gases Arterial blood gasesBlood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.ImageRead Article Now Book Mark Article Blood tests (serum calcium) Serum calciumThe calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...ImageRead Article Now Book Mark Article Bone biopsy (rarely done) Bone biopsyA bone lesion biopsy is the removal of a piece of bone or bone marrow for examination.ImageRead Article Now Book Mark Article Bone x-rays Bone x-raysA bone x-ray is an imaging test to look at the bones.ImageRead Article Now Book Mark Article Serum alkaline phosphatase (ALP) Serum alkaline phosphataseAlkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. A blo...ImageRead Article Now Book Mark Article Serum phosphorusSerum phosphorusThe phosphorus blood test measures the amount of phosphate in the blood.ImageRead Article Now Book Mark Article Other tests and procedures include the following:ALP isoenzyme ALP isoenzymeAlkaline phosphatase (ALP) is an enzyme found in many body tissues such as liver, bile ducts, bone, and intestine. There are several different struc...ImageRead Article Now Book Mark Article Calcium (ionized) Calcium (ionized)Ionized calcium is calcium in your blood that is not attached to proteins. It is also called free calcium. All cells need calcium in order to work. ...ImageRead Article Now Book Mark Article Parathyroid hormone (PTH) PTHThe PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...Read Article Now Book Mark Article Urine calciumUrine calciumThis test measures the amount of calcium in the urine. All cells need calcium in order to work. Calcium helps build strong bones and teeth. It is ...ImageRead Article Now Book Mark Article Treatment The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated to prevent the disease from returning.Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish liver and processed milk.Exposure to moderate amounts of sunlight is encouraged. If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed.Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require surgery to correct them. Outlook (Prognosis) The disorder may be corrected by replacing vitamin D and minerals. Laboratory values and x-rays usually improve after about 1 week. Some cases may require large doses of minerals and vitamin D.If rickets is not corrected while the child is still growing, skeletal deformities and short stature may be permanent. If it is corrected while the child is young, skeletal deformities often improve or disappear with time. Possible Complications Possible complications are: Long-term (chronic) skeletal pain ChronicChronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...ImageRead Article Now Book Mark Article Skeletal deformities Skeletal fractures, may occur without cause When to Contact a Medical Professional Contact your child's health care provider if you notice symptoms of rickets. Prevention You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in their diet. Children who have digestive or other disorders may need to take supplements prescribed by the child's provider.Kidney (renal) diseases that may cause poor vitamin D absorption should be treated right away. If you have renal disorders, monitor calcium and phosphorus levels regularly.Renal disordersA renal disorder refers to any disease of the kidneys. Urological disorders are diseases of the kidneys and urinary tract. This includes the kidneys...ImageRead Article Now Book Mark Article Genetic counseling may help people who have a family history of inherited disorders that can cause rickets.Open ReferencesReferencesBhan A, Rao AD, Bhadada SK, Rao SD. Rickets and osteomalacia. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 31.Demay MB, Krane SM. Disorders of mineralization. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 71.Greenbaum LA. Vitamin D deficiency (rickets) and excess. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 64.Weinstein RS. Osteomalacia and rickets. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 231.