Description of Disease
Rickets is a disease that is characterized by a decrease in bone density.
This reduction is due to a decrease in the
rate of osteoid synthesis to a level that is insufficient to compensate
normal bone lysis. There is diminished
calcification in the cartilage of the growth plate of the bone. There
are many different types of Rickets that affect
the population but all types are based on a deficiency. The
differentiating factor in diagnosing the type of
Rickets lies within the acquisition or the type
of patients in which the disease appears.
Vitamin D Deficiency
type occurs in infants and children, which is a result of a lack of sun
exposure and vitamin D in their diet.
Vitamin D deficiency Rickets is not very common in the present day and
is most commonly seen in breastfed babies
that have a limited exposure to sunlight. Premature babies may
form neonatal rickets, which results in spontaneous
fractures, impaired growth, and respiratory distress.
Neonatal rickets is usually seen within the first 8 to 10 weeks of life
and is diagnosed with a chest x-ray.
The radiographic appearance could show fractured ribs or just softened
which would result in the ribs having an irregular
and frayed appearance. Vitamin D deficiency rickets may
appear in patients that have disorders of the small
bowel, abnormalities of the hepatobiliary system, or
gastrointestinal malabsorption problems. Intestinal surgery can also
cause rickets by decreasing the mineralization
of the bones. A related deficiency is the deficiency of 25(OH)
Vitamin D that occurs in patients with neonatal
hepatitis, biliary atresia, liver disease, anticonvulsant therapy, and
vitamin-D-dependent rickets. A patient with
renal osteodystrophy may develop rickets due to the deficiency
of 1,25(OH2) vitamin D.
Rickets is caused by a lack of Vitamin D and other factors contribute to
the cause of the
disease. The main factors are the ratios
and quantities of calcium and phosphorus available in the body,
the speed and growth of the individual, and the ultraviolet ray filtering
power of the
atmosphere (Evans, 1994). Vitamin D has
three different forms: vitamin D, 25(OH) vitamin D, and 1,25(OH2)
vitamin D. These vitamins come from sunlight therefore, if a person
insufficient amount of sunlight, they could be
at risk for developing Rickets.
Signs and Symptoms
Weakening and deformity of the bones
Infants may suffer respiratory distress
Few symptoms before the advanced stage
most effective way to diagnose Rickets is through the evaluation of x-rays.
early stages of the disease will be noticeable
in the distal ends of the radius and ulna. The ulna
will show significant changes will the radius
appears to be normal. The main changes are the irregular fraying
of the provisional zone of calcification.
It is normally sharply defined, however, with Rickets it becomes
fuzzy and fades into the soft tissue density of the adjacent cartilage
(Evans, 1994). Radiographic findings
will show abnormal increased axial height of the cartilaginous portion
of the epiphyseal plate while cupping and
widening of the ends of the long bones. Flat bones such as the skull
or sternum may have an appearance of decreased density and become deformed
and thin in children.
Treatment and Prognosis
main treatment for Rickets is with vitamin D therapy. One type of
treatment is a single day therapy, stosstherapy,
which is one large dose of vitamin D. Stosstherapy is used for patients
with nutritional vitamin D deficiency. The response of this treatment
is usually within 5 to 7 days. Vitamin
D and calcium doses are also a common treatment for Rickets. Almost
all patients are cured after treatment but in some severe cases there may
be residual deformities. The patient may still
suffer from bowing of the bones, knock knees, pathological fractures, or
saber shin. The majority of treated
Rickets patients will go on to live normal and unaffected lives.
The main aspect that must be considered is
the cause for the vitamin defect and then the disease can be accurately
and effectively treated. The prognosis for Rickets patients is remarkable
Eisenberg, Ronald L. and Cynthia A. Dennis,
(1995) Comprehensive Radiographic Pathology: Second Edition.
St. Louis, MS: Mosby Inc.
Finberg, L. & BR. Shah. Single-day therapy
for nutritional vitamin D-deficiencies rickets. Journal of Pediatrics.
Kaplan, FS. Osteopetrorickets. Pathophysiology
and Treatment. Clinical Orthopaedics & Related Research.
Rabinowitz, Jack. Skeletal Radiology,
(1992) Kingsport; Mc-Graw Companies.