Osteomalacia and rickets

Overview

This condition is mostly caused by a lack of vitamin D. It affects bone development and causes soft, weak bones (e.g. deformities). The condition is called rickets in children and osteomalacia in adults. Ensuring a sufficient supply of vitamin D (sunlight, diet) is recommended as a preventive measure.

Symptoms

Rickets (from infancy):

• Elastic bone that can be “pushed in” at the back of the skull
• Delayed closure of the fontanelles
• “Rachitic rosary”: prominent knobs of bone at the joints between the ribs and rib cage (looks like a string of pearls)
• Delay in teeth coming through, defective tooth enamel, cavities
• Skeletal deformities (most often affecting the leg bones, ribs and spine)
• Muscle weakness, increased muscle excitability, seizures

Osteomalacia (in adults):

• Dull bone pain (particularly in the spine, pelvis and upper thighs)
• Complication: spontaneous bone fractures (i.e. without external trauma)
  

Causes and treatment

Causes

• Vitamin D deficiency
  • Reduced UV radiation (sunlight)
  • Reduced intake via food (malnutrition)
  • Reduced intestinal absorption (e.g. bowel diseases)
• Impaired vitamin D metabolism
  • Liver and kidney diseases
  • Genetic (rarely)
    
• Vitamin D is required to aid the absorption of minerals such as calcium and phosphate into the bones in order to make the still-soft bones of infants hard and stable (mineralisation). Osteomalacia is the demineralisation and softening of previously fully developed bones.
  
  

Further treatment by your doctor / in hospital

Possible tests

• Physical examination
• Blood test
• X-ray

Possible therapies

• Treatment of the underlying disease
• Vitamin D deficiency: vitamin D and calcium supplements
  

What can I do myself?

• Regularly spend time outside and engage in outdoor physical activities (follow recommendations for sun protection)
• Balanced and varied diet (according to the Swiss food pyramid)
  • Important sources of vitamin D: oily fish (e.g. salmon, herring, mackerel), liver, butter, full-cream milk, cheese, eggs
• Vitamin D supplements for all infants and children up to the age of three
• In winter: ensure vitamin D supply via food and nutritional supplements or vitamin D supplements
• Persons at risk (mostly people with too little sun exposure and the over 60s): take vitamin D supplements throughout the year

When to see a doctor?

• Unusually elastic and bendy bones
• Muscle pain, cramps, twitching
• Dull bone pain
• Spontaneous bone fractures
• Liver, kidney and bowel diseases
• Known malnutrition
  

Further information

Swiss Society of Paediatrics (Schweizerische Gesellschaft für Pädiatrie)
www.swiss-paediatrics.org

Synonyms

rickets, osteomalacia, vitamin d deficiency, juvenile osteomalacia, rachitis, bone softening