Overview

Rickets is a condition that affects bone development in children. It causes bone pain, poor growth and soft, weak bones that can lead to bone deformities.

Adults can experience a similar condition, which is known as osteomalacia or soft bones.

What causes rickets?

A lack of vitamin D or calcium is the most common cause of rickets. Vitamin D largely comes from exposing the skin to sunlight, but it's also found in some foods, such as oily fish and eggs. Vitamin D is essential for the formation of strong and healthy bones in children.

In rare cases, children can be born with a genetic form of rickets. It can also develop if another condition affects how vitamins and minerals are absorbed by the body.

Who is affected?

Rickets was common in the past, but it mostly disappeared in the western world during the early 20th century after foods like margarine and cereal were fortified with vitamin D.

However, in recent years, there's been an increase in cases of rickets in the UK. The number of rickets cases is still relatively small, but studies have shown a significant number of people in the UK have low levels of vitamin D in their blood.

Any child who doesn't get enough vitamin D or calcium either through their diet, or from sunlight, can develop rickets. But the condition is more common in children with dark skin, as this means they need more sunlight to get enough vitamin D, as well as children born prematurely or taking medication that interferes with vitamin D.

Treating rickets

For most children, rickets can be successfully treated by ensuring they eat foods that contain calcium and vitamin D, or by taking vitamin supplements..

Some families are eligible for free vitamin supplements from the government's Healthy Start Scheme.  Find out if you're eligible and how to apply.

If your child has problems absorbing vitamins and minerals, they may need a higher dose or a yearly vitamin D injection.

Preventing rickets

Rickets can easily be prevented by eating a diet that includes vitamin D and calcium, spending some time in sunlight, and if necessary, taking vitamin D supplements.

When to seek medical advice

Take your child to see your GP if they have any of the signs and symptoms of rickets.

Your GP will carry out a physical examination to check for any obvious problems. They may also discuss your child's medical history, diet, family history, and any medication they're taking.

A blood test can usually confirm a diagnosis of rickets, although your child may also have some X-rays or possibly a bone density scan (DEXA scan). This is a type of X-ray that measures the calcium content in bones.

If you're an adult and you’re experiencing bone pain or muscle weakness you should also see your GP to get it checked out.

Symptoms

Rickets causes a child's bones to become soft and weak, which can lead to bone deformities.

The signs and symptoms of rickets can include:

• pain – the bones affected by rickets can be sore and painful, so the child may be reluctant to walk or may tire easily; the child's walk may look different (waddling)
• skeletal deformities – thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spine
• dental problems – including weak tooth enamel, delay in teeth coming through and increased risk of cavities
• poor growth and development – if the skeleton doesn't grow and develop properly, the child will be shorter than average
• fragile bones – in severe cases, the bones become weaker and more prone to fractures

Some children with rickets may also have low levels of calcium in their blood (hypocalcaemia). This can make the symptoms of rickets worse and can also cause muscle cramps, twitching, tingling in the hands and feet, and fits.

Adults can experience similar symptoms such as bone pain, muscle weakness and fragile bones that are more prone to fractures. In adults, these symptoms are known as osteomalacia.

Find out more about symptoms of osteomalacia from Versus Arthritis.

When to seek medical advice

If your child has any signs or symptoms of rickets, such as bone pain, delayed growth, muscle weakness or skeletal problems, take them to your GP for a check-up.

If you are an adult and you're experiencing bone pain or muscle weakness see your GP to get it checked out.

Who can get it

Rickets usually occurs because of a lack of vitamin D or calcium, although it can also be caused by a genetic defect or another health condition.

Lack of vitamin D and calcium

The most common cause of rickets is a lack of vitamin D or calcium in a child’s diet. Both are essential for children to develop strong and healthy bones.

The main sources of vitamin D are:

• Sunlight – your skin produces vitamin D when it is exposed to the sun. We get most of our vitamin D this way.
• Food – vitamin D is also found in foods such as oily fish, eggs and fortified breakfast cereals.
• dietary supplements

Calcium is commonly found in dairy products, such as milk, cheese and yoghurt, and green vegetables,such as broccoli and cabbage.

Over time, vitamin D or calcium deficiency will cause rickets in children and osteomalacia (soft bones) in adults.

Who's at risk?

Any child who does not get enough vitamin D or calcium can develop rickets, but there are certain groups of children who are more at risk.

For example, rickets is more common in children of Asian, African-Caribbean and Middle Eastern origin because their skin is darker and needs more sunlight to get enough vitamin D.

Babies born prematurely are also at risk of developing rickets because they build up stores of vitamin D while they're in the womb. Babies who are exclusively breastfed, especially for longer than six months, may also be at risk of vitamin D deficiency.

It is recommended that:

• adults, including pregnant and breastfeeding women, and children over 4 years old should consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D from at least October to March
• babies from birth to 1 year of age, whether exclusively or partially breastfed, should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough
• babies fed infant formula do not need a vitamin D supplement until they are receiving less than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D
• children aged 1 to 4 years old should be given a daily supplement containing 10mcg of vitamin D

Genetic defect

Rare forms of rickets can also occur in some inherited (genetic) disorders. For example, hypophosphatemic rickets is a genetic disorder where the kidneys and bones deal abnormally with phosphate.

Phosphate binds to calcium and is what makes bones and teeth hard. This leaves too little phosphate in the blood and bones, leading to weak and soft bones.

Other types of genetic rickets affect certain proteins in the body that are used by vitamin D.

Underlying conditions

Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption of vitamins and minerals.

Treatment

As most cases of rickets are caused by a vitamin D and calcium deficiency, it is usually treated by increasing a person's intake of vitamin D and calcium.

Vitamin D and calcium can be increased by:

• eating more foods that are rich in calcium and vitamin D
• taking daily calcium and vitamin D supplements

Sunlight also helps our bodies to make vitamin D, so you may be advised to increase the amount of time your child spends outside for safe exposure to sunlight.

Your GP will advise you about how much vitamin D and calcium your child will need to take. This will depend on their age and the cause of the rickets. If your child has problems absorbing vitamins, they may need a higher dose.

Treating complications and related conditons

When rickets occurs as a complication of another medical condition, treating the underlying condition will often cure the rickets.

If your child has a bone deformity caused by rickets, such as bowed legs or curvature of the spine, your GP may suggest treatment to correct it. This may include surgery.

Genetic rickets

A combination of phosphate supplements and a special form of vitamin D is required for the treatment of hypophosphatemic rickets, where a genetic defect causes abnormalities in the way the kidneys and bones deal with phosphate.

Children with other types of genetic rickets need very large amounts of a special type of vitamin D treatment.

Supplement side effects

It's very unusual to get side effects from vitamin D, calcium or phosphate supplements if they're given in the correct dose. Your doctor will advise you about how much supplement is needed, for how long, and the monitoring of treatment.

If the vitamin D or calcium dose is too high or the treatment is continued for too long or isn't carefully monitored, it can raise calcium levels in the blood. This can result in a condition called hypercalcaemia.

Symptoms of hypercalcaemia include:

• passing a lot of urine
• feeling thirsty
• reduced appetite
• nausea, abdominal pain, constipation and vomiting
• dizziness and headaches
• bone pain

See your GP immediately if you or your child has any of these symptoms.

Osteomalacia

If you have osteomalacia – the adult form of rickets that causes soft bones – treatment with supplements will usually cure the condition.

However, it may be several months before any bone pain and muscle weakness is relieved.

You should continue taking vitamin D supplements regularly to prevent the condition returning.

Prevention