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Rickets

Rickets is a condition that results in a loss of bone mineralisation (soft bones), or can be thought of as the paediatric version of Osteomalacia. It's caused by a deficiency in Vitamin D or Calcium.


Vitamin D is needed for calcium (Ca) and phosphate (Ph) absorption from the gut and kidneys, as well as regulating bone turnover and promoting bone reabsorption to boost Ca levels. A deficiency of it leads to a low Ca and Ph, therefore less bone mineralisation. This low Ca can also lead to secondary hyperparathyroidism as a result (raised PTH as a response).


Causes of Vitamin D deficiency:

  • Darker skin

  • Lack of sun exposure

  • Malabsorption e.g. IBD, Coeliac

  • CKD


Presentation

  • Bone deformity – Bowing of legs, Knock knees

  • Aching bones and joints

  • Pathological fractures

  • Lethargy

“Anteroposterior (AP) view of the legs in a 2 year old child with rickets.” © Michael L. Richardson CC BY-SA 1.0 (https://creativecommons.org/licenses/by-sa/1.0/) “The so called incurable cases” © Umeedhom CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Investigations

  • 25-Vit D - < 25 nmol/L is diagnostic of a deficiency

  • XR

  • Bloods – Ca, Ph, PTH, ALP, FBC, CRP, ESR, U&E, LFTs, TFTs, Anti-TTG


Management

  • Prevention – Breastfed babies are at higher risk of Vit D deficiency than formula fed (formula has a lot more Vit D)

  • Vit D supplementation - Ergocalciferol (Vit D)



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