Rickets

Alternative names:

deficiency - vitamin D; osteomalacia in children; pediatric osteomalacia; renal osteodystrophy; renal rickets; vitamin D deficiency

Symptoms:

• bone pain or tenderness
  • arms, legs, spine, pelvis

• skeletal deformities
  • bowlegs
  • forward projection of the breastbone (pigeon chest)
  • "bumps" in the rib cage ("rachitic rosary")
  • asymmetrical or odd-shaped skull
  • spine deformities (spine curves abnormally, including scoliosis or kyphosis)
  • pelvic deformities

• increased tendency toward bone fractures
• dental deformities
  • delayed formation of teeth
  • defects in the structure of teeth, holes in the enamel
  • painful teeth, aching aggravated by sweets, or by cold/hot food or drinks
  • increased incidence of cavities in the teeth (dental caries)

• fever, especially at night
• restlessness, especially at night
• weakness, progressive
  • decreased muscle tone (loss of muscle strength)
  • decreased muscle development

• muscle cramps
• impaired growth
  • short stature (adult is less than 5 feet tall)
  • growth, slow (child 0-5 years)

• pectus excavatum
• sutures - separated

Signs and tests:

A musculoskeletal examination reveals tenderness or pain of the bone itself, rather than joints or muscles. In some cases, tetany (prolonged muscle spasm) may occur if serum levels of calcium are low. Chvostek's sign may be positive (a spasm of facial muscles with tapping over the facial nerve) indicating low serum levels of calcium.

• Serum calcium and serum phosphorus may be low.
• Serum alkaline phosphatase may be high.
• Arterial blood gases may reveal metabolic acidosis.
• Bone X-rays may show decalcification or changes in the shape/structure of the bones.
• A bone biopsy is rarely performed but will confirm rickets.

Other tests and procedures to determine cause may be performed, such as:

• a PTH
• a calcium; urine
• a calcium (ionized)
• ALP (alkaline phosphatase) isoenzyme