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Rickets/Osteomalacia

Children with rickets have abnormal bone formation resulting from inadequate calcium in their bones. This lack of calcium can result from inadequate dietary calcium,1 inadequate exposure to sunshine (needed to make vitamin D), or from not eating enough vitamin D—a nutrient needed for calcium absorption. Vitamin D is found in animal foods, such as egg yolks and dairy products.

Rickets can also be caused by conditions that impair absorption of vitamin D and/or calcium, even when these nutrients are consumed in appropriate amounts. Activation of vitamin D in the body requires normal liver and kidney function. Damage to either organ can cause rickets. Some variations of rickets do not respond well to supplementation with vitamin D and calcium. Proper diagnosis must be made by a healthcare professional.

Osteomalacia is an adult version of rickets. This condition is treated with vitamin D, sometimes in combination with calcium supplements. Osteomalacia should be diagnosed, and its treatment monitored, by a doctor.

Checklist for Rickets

Rating Nutritional Supplements Herbs
3Stars Calcium
Vitamin D		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of rickets and osteomalacia? In children, symptoms of rickets include delayed sitting, crawling, and walking; pain when walking; and the development of bowlegs or knock-knees. Symptoms of osteomalacia include bowing of the legs and a decrease in height.

How is it treated? Conventional treatment of rickets and osteomalacia includes oral vitamin D supplementation, sometimes accompanied by intravenous calcium. In addition, doctors may recommend the use of artificial ultraviolet B radiation or increased exposure to sunlight.

Dietary changes that may be helpful: Dietary changes should only be considered if a medical professional has diagnosed rickets and determined the cause to be a simple nutritional deficiency. Rickets is more likely to occur in a child consuming a pure vegan diet (which does not include animal products and thus no vitamin D) than in a child consuming milk or other animal foods. Dark skin and/or a lack of sunlight exposure (which reduces the amount of vitamin D made in the skin) also increase the risk of developing rickets.

The few foods that contain vitamin D include egg yolks, butter, vitamin D-fortified milk, fish liver oil, breast milk, and infant formula. Calcium, in addition to being present in breast milk and formula, is found in dairy products, sardines, salmon (canned with edible bones), green leafy vegetables, and tofu. Vegans may use supplements instead of eggs and dairy as sources for both calcium and vitamin D.

Lifestyle changes that may be helpful: Direct exposure of the skin (i.e., hands, face, arms, etc.) to sunlight stimulates the body to manufacture vitamin D. However, both clothing and use of a sunscreen prevent the ultraviolet light that triggers the formation of vitamin D from reaching the skin. Depending on latitude, sunlight during the winter may not provide enough ultraviolet light to promote adequate vitamin D production. At other times during the year, even 30 minutes of exposure per day will usually lead to large increases in the amount of vitamin D made. If it is difficult to get sunlight exposure, full-spectrum lighting can be used to stimulate vitamin D production.

Nutritional supplements that may be helpful: Vitamin D and calcium supplements should be used to treat rickets only if a medical professional has diagnosed rickets and has also determined the cause is a nutritional deficiency. Amounts needed to treat rickets should be determined by a doctor and will depend on the age, weight, and condition of the child. For prevention of rickets, 400 IU of vitamin D per day is considered reasonable. Doctors often suggest 1,600 IU per day for treating rickets caused by a lack of dietary vitamin D.

The National Institutes of Health has stated that the following amounts of total calcium intake per day are useful to prevent rickets:

• 400 mg until six months of age

• 600 mg from six to twelve months

• 800 mg from one year through age five

• 800–1,200 mg from age six until age ten

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

References:

1. Thacher TD, Fischer PR, Pettifor JM, et al. A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. N Engl J Med 1999;341:563–8.