Nutritional Rickets, a public health issue in many countries, including India

Rickets is a bone disease that affects infants and young children. Their bones fail to develop properly. Nutritional rickets is related to low intake of calcium, vitamin D or phosphorus and among these three nutritional rickets due to low calcium and/or vitamin D intake is the most common.

According to research from WHO in India on investigation (radiographically) 3 per 1000 individual from age 1-18 years are found to be affected from ricket. Nutritional rickets remains a public health problem in many countries including India, despite dramatic decline in the prevalence of the condition in many developed countries since the discoveries of vitamin D and the role of ultraviolet light in prevention.

About 80 % of our vitamin D comes from exposure to the sun. When direct sunlight hits our skin, the ultraviolet radiation converts a skin substance called 7-dehydrocholesterol into vitamin D. There are also very negligible amounts of vitamin D in some foods. So, food sources alone are usually not enough to maintain the levels of Vitamin D that our body needs. Once vitamin D is made in the skin or absorbed from food through the intestine, it is changed into its active form – a hormone – by the liver and kidneys. It is then available to help our body build strong bones and teeth, through the process of ‘mineralisation’ this pathology leading to symptoms such as painful bones, muscle weakness, cramps and spasms slowed growth and development. Increased risk of broken bones, including spontaneous breaks that occur by themselves without pressure or trauma, dental problems such as teeth failing to form or being slow to emerge, deformed teeth or soft tooth enamel prominent forehead and a large front fontanelle (soft spot) in infants, deformities of the skeleton such as bowed legs, kyphosis (‘hunch-back’), scoliosis (sideways curves of the spine), outward jutting breastbone or abnormal skull shape. Some of the contributing factors and causes of rickets include not enough exposure of the skin to sunlight, skin colour – the skin pigment in children with naturally dark skin tends to absorb less sunlight than fair skin. It is important to consult your family doctor or health care provider if these signs and symptoms are present in your child.

 Currently, there are no internationally accepted diagnostic criteria for rickets. In general, rickets has been screened and diagnosed based on a combination of parameters, including health history (e.g., breastfeeding, calcium intake, use of vitamin D and calcium supplements) and clinical signs based on physical examination, biochemical testing and radiographs. Radiographs have been traditionally considered to be the gold standard in diagnosing rickets. Now rickets may be diagnosed using a number of tests including physical examination, blood tests, long bone x-rays, Bone scans.

Treatment options include, improved sunlight exposure improved diet that includes adequate intake of calcium and vitamin D, oral vitamin D supplements – these may need to be taken for about three months. Special forms of vitamin D supplements – for people whose bodies can’t convert vitamin D into its active form. Treatment for any underlying disorder is surgery to correct bone deformities. High-dose supplements of vitamin D are available. These require special prescription by a doctor. The use of special form of vitamin D supplement i.e., vitamin D3 may be the most effective option for the treatment of rickets. Prevention options can be done only by understanding the risk factors for vitamin D deficiency and taking steps to prevent it. Suggestions for preventions are sunlight – a sensible balance of sun exposure and sun protection can protect against vitamin D deficiency without putting your child at risk of skin cancer but protect your child’s skin from the sun during peak UV times with clothing, shade and/or sunscreen, Diet – include food rich in vitamin D and calcium in your child’s diet. Foods naturally containing vitamin D include oily fish (especially sardines, salmon, herring and mackerel), liver and egg yolks. Foods ‘fortified’ with vitamin D include some margarines and some milks (including fortified baby formula milk), Supplements – consult with your child’s doctor or health provider about whether your child should be prescribed supplements.

At last things to remember are that the rickets is a curable bone disease but as we all know prevention is better than cure, it is better to take prevention. Also take help of your child’s doctor for its early diagnosis and treatment. 

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