X-ray of the legs in a two-year-old child with rickets
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Osteomalacia (pronounced /ˌɑstioməˈleɪʃiə/),is also referred to as bow-leggedness or rickets - taken from the Greek word ῥάχις (rhákis), meaning "spine". It is a disorder which relates directly to Vitamin D deficiency, which causes a lack of calcium being absorbed. Because calcium is an essential nutrient which aids bone rigidity, the lack of it being absorbed into the body causes fragile or malformed bones, which are unable to support the weight of a growing body. Although osteomalacia can occur in adults, the majority of cases occur in children with poor nutrient intake usually resulting from famine or starvation during early stages of childhood.

Aetiology

Vitamin D is created by the body when it is exposed to UV light, which is more commonly known as being present in sunlight. In 1916, German medical research scientist and pediatrician Kurt Huldschinsky (1883-1940) discovered that exposing patients who had osteomalacia to artificially generated ultra-violet light, or by therapeutically exposing them to sunlight, he was able to yield quicker recovery than other methods, such as supplementation of dairy products within a patient's diet.

Vitamin D3 is produced naturally by the human body on exposure to UVB in sunlight. Vitamin D is also added to milk, milk products, and multi-vitamin pills through a process originally patented by Harry Steenbock. Some people who do not get enough sun exposure, milk products, or green vegetables may also develop the disease. Deficiency of calcium can also cause rickets, particularly in some developing countries where the intake of calcium-rich products such as leafy greens, nuts, and seeds is low.

Hereditary rickets is caused by an inherited disease that interferes with phosphate absorption in the kidney or by Renal tubular acidosis, in which calcium is taken from the bones to counteract acid produced in the kidneys. Rickets can also be caused by certain liver diseases.

Manifestations of disease

Rickets causes bone pain, slowed growth in children, dental problems, muscle loss and increased risk of fractures (easily broken bones). Medical problems seen in children with rickets are

  1. Vitamin D deficiency,
  2. Skeletal deformity,
  3. Growth disturbance,
  4. Hypocalcaemia (low level of calcium in the blood),
  5. Tetany (uncontrolled muscle spasms).

The X-ray, or radiograph, in the article is the classic image of advanced rickets sufferers: bow legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life.

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AAP guidelines on Rickets and Vitamin D supplementation - American Academy of Pediatrics
From American Family Physician, 6/1/03 by Carrie Morantz

All healthy infants within the first two months of life, children, and adolescents should receive vitamin D supplementation to prevent rickets and vitamin D deficiency, according to a new clinical report from the American Academy of Pediatrics (AAP). "Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake" appears in the April 2003 issue of Pediatrics and is available online at www.aap.org/ policy/s010116.html.

A supplement of 200 IU per day of vitamin D is suggested for the following:

* All breastfed infants unless they are weaned to at least 500 mL per day of vitamin D-fortified formula or milk. Vitamin D supplementation should begin within the first two months of life.

* All nonbreastfed infants who are ingesting less than 500 mL per day of vitamin D-fortified formula or milk.

* Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.

The AAP report affirms guidelines from the National Academy of Sciences. Public health officials are becoming increasingly concerned about continued reports of infants who have been diagnosed with rickets, the bone-softening disease caused by insufficient exposure to sunlight and inadequate vitamin D intake. Unfortunately, an infant may be vitamin D-deficient long before being diagnosed with rickets because the symptoms are not obvious.

Sunlight is a major source of vitamin D, but sunlight exposure is difficult to measure. Factors such as skin exposure and the amount of pigment in an infant's skin affect how much vitamin D the body produces from sunlight. Children should wear sunscreen when they are in the sun. Sunscreen, however, prevents the skin from making vitamin D.

Exclusively breastfed infants are at increased risk of vitamin D deficiency and rickets. This is because the amount of vitamin D contained in human milk is not sufficient to prevent rickets.

Most bottle-fed infants should be able to get their daily requirements of vitamin D from formula, because all infant formulas sold in the United States contain a sufficient amount of vitamin D.

COPYRIGHT 2003 American Academy of Family Physicians
COPYRIGHT 2003 Gale Group

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