Rickets

Rickets is a bone disorder in children that causes their bones to become soft and weak, making them more likely to bend and break. The main culprits behind this condition are a lack of calcium, phosphate, and vitamin D. All these nutrients are essential for healthy bone growth. Without a diet rich in these nutrients or enough sunlight, their bones will not be able to harden properly.

Certain children are at a higher risk of developing rickets. Children who have little to no outdoor time and those with darker skin or premature birth are at a higher risk. Sunlight helps your body produce vitamin D. You can also get a natural boost through foods like egg yolks and fatty fish.

The good news is that with early diagnosis and the proper treatment, it is possible to reverse the bone damage caused by rickets. Understanding rickets disease is key to protecting the growing bones of children and preventing long-term issues.

1.0Types of Rickets

Rickets isn’t just one condition. It comes in several forms, each with its own cause and characteristics:

• Nutritional Rickets: This is the most common type and occurs when a child doesn’t get enough vitamin D, calcium, or phosphorus from their diet. It's especially common in areas where sunlight is limited or where diets lack fortified foods. Children who follow strict vegan diets or are lactose-intolerant are at higher risk.
• Hypophosphatemic Rickets: A rare inherited disorder, usually passed down through families in an X-linked pattern. In this condition, the kidneys are unable to retain phosphate, a mineral essential for bone strength. Despite normal or even high vitamin D intake, low phosphate levels prevent bones from mineralising properly.
• Renal Rickets (Renal Osteodystrophy): Seen in children with chronic kidney disease, this type results from the kidneys’ inability to regulate calcium and phosphate levels effectively. The kidneys also fail to convert vitamin D into its active form, leading to bone weakness.
• Vitamin D–D-Dependent Rickets: Another genetic form, where the body either can't convert vitamin D into its active form or the bones don’t respond to vitamin D at all. These children may require lifelong treatment with specialised supplements and careful monitoring.

2.0Symptoms of Rickets

Children with rickets often show clear physical signs, including:

• Stunted growth and short stature
• Soft, fragile bones that break easily
• Bone pain in the arms, legs, spine, or pelvis
• Delayed tooth development or dental problems
• Skeletal deformities like bowed legs or a protruding chest bone

3.0Causes of Rickets

No matter which type of rickets a child develops, the underlying issue is almost always a deficiency of vitamin D, calcium, or phosphate, all nutrients that are essential for strong, healthy bones. When the body lacks any of these, bones fail to mineralise properly, resulting in weakness, deformities, and growth problems. The three main types of rickets disease are:

• Nutritional Rickets is caused by a poor intake of vitamin D or calcium.
• Hypophosphatemic Rickets is a genetic disorder affecting phosphate retention.
• Renal Rickets which results from chronic kidney disease interfering with mineral balance.

Several factors can lead to these deficiencies:

1. Premature Birth – Babies born early may have lower stores of calcium, phosphate, and vitamin D.
2. Limited Sunlight Exposure – Especially common in regions with long winters or in children who spend little time outdoors.
3. Genetic Conditions – Inherited metabolic disorders, such as hypophosphatemic rickets, affect phosphate handling in the body.
4. Darker Skin Tone – Higher melanin levels reduce the skin's ability to produce vitamin D from sunlight.
5. Maternal Deficiency – Babies born to mothers low in vitamin D may start life already deficient.
6. Kidney Disorders – Chronic kidney disease interferes with the body's ability to regulate calcium and phosphorus.
7. Poor Nutrition – Children who avoid dairy or follow restricted diets may not get enough calcium and vitamin D from food.

Understanding these causes of rickets is key to both prevention and effective treatment.

4.0Who’s at Risk?

5.0Treatment of Rickets

The good news? Rickets are highly treatable if caught early.

• A vitamin D-rich diet (plus calcium and phosphorus) is the first step.
• Sunlight exposure is key. Just 15–30 minutes a day can help.
• Vitamin D supplements are recommended for breastfed babies and high-risk children.
• For inherited forms, doctors may prescribe vitamin D hormones and phosphate medications.
• In severe cases, braces or surgery may be needed to correct bone deformities.