Rickets

What is rickets?

Rickets is a condition which affects the development of bones in children. Caused in most cases by a deficiency of vitamin D and subsequently also calcium, the condition can lead to the bones becoming soft and weak. This process can ultimately lead to bone deformity if left untreated.

Rickets is most common in children, but its equivalent can also occur in adults. In such cases, the condition is known as osteomalacia or “soft bones”.

Treating rickets generally involves following a nutritionally-balanced diet and/or taking vitamin supplements. In most cases, the condition can be treated successfully.[1]

Symptoms of rickets

Symptoms of rickets may include:[2][3]

  • Growth and development issues: Children may be shorter than average due to bone development problems.
  • Pain: Bones may become sore or painful, especially when pressure is applied. This may lead to a child being reluctant to walk or get up from a sitting position, and they may appear to walk abnormally.
  • Brittle bones: Bones may become weaker than normal, leading to an increased likelihood of fracturing and breaking.
  • Dental issues: May include weak tooth enamel, slow development of teeth and an increased likelihood of cavities.
  • Deformities: The ankles, wrists and knees may become thicker than normal. Bowed legs, a softening of the skull and – less commonly – a bending of the spine may also occur.

If any of these symptoms are present, medical attention should be sought.

Many of the same symptoms may also occur in adults experiencing osteomalacia. However, adults tend to report more bone pain and tenderness than children with rickets.

Causes of rickets

Rickets can be caused by a variety of factors, including:

  • Vitamin D and/or calcium deficiency
  • Genetics
  • Underlying conditions

Vitamin D and calcium deficiency

A deficiency of vitamin D and/or calcium is by far the most common cause of rickets in children. The majority of children will receive sufficient amounts of calcium through their diet. However, it is rare for one’s diet to contain sufficient quantities of vitamin D, and many people choose to use a vitamin D supplement in order to ensure that they get the required amount.

Foodstuffs containing vitamin D and calcium include:[4]

  • Vitamin D: Small quantities of vitamin D are found in oily fish, e.g. salmon, eggs, some dairy products like cheese and some cereals.
  • Calcium: Found in dairy products such as cheese, milk and yoghurt, as well as green vegetables such as kale and broccoli.

Vitamin D and calcium supplements are widely available. Consulting a physician when choosing a vitamin supplement is recommended, in order to ensure that it is appropriate for the individual.

Factors that make children more likely to develop rickets related to vitamin D or calcium deficiency include:[5]

  • Dark skin: Dark skin contains more melanin than light skin, increasing the amount of UV-B light/sun exposure needed to produce vitamin D.
  • Lack of exposure to sun: Children who spend the majority of their time indoors, or lack exposure to sunlight for any other reason, are less likely to produce a sufficient amount of vitamin D. Additionally, if children live in countries that are far away from the equator and/or in the northern hemisphere, even if they spend plenty of time outdoors, the sunlight may not be strong enough to effectively stimulate vitamin D production.
  • Pre-existing conditions: Certain conditions – such as liver disease, kidney disease and celiac disease – can affect the way the body produces and controls vitamin D.
  • Breastfeeding: Children who are exclusively breastfed and have dark skin and/or a mother who is lacking in vitamin D have a higher chance of developing rickets.

Genetics

In rare cases, rickets can run in families.

The most common form is hereditary hypophosphatemic rickets, which results from mutations in several genes. This condition renders the kidneys unable to retain phosphate, leading to a deficiency of this important chemical. Phosphate plays a central role in bone formation and growth.[6][7]

Underlying conditions

In rare cases, rickets can develop as a result of underlying conditions (some of which are hereditary) of the liver, kidneys or intestines. These conditions typically affect the way the body produces, absorbs and retains minerals and vitamins, and may lead to deficiencies. These include phosphate and calcium deficiencies, which can result in rickets if left untreated.[7]

Diagnosing rickets

Diagnosing rickets will generally involve a doctor taking the person’s full medical history, followed by blood tests to check the vitamin D, phosphate, calcium and parathyroid hormone levels. In some cases, blood tests may also be used to check liver and kidney function.

Sometimes, X-rays may also be used to check for skeletal changes or deformity. A dual energy X-ray absorptiometry (DEXA) may also be used to check bone calcium levels.[7]

Rickets treatment

The necessary treatment route for rickets depends on the condition’s underlying cause.

When rickets is caused by a deficiency of vitamin D or calcium, increasing the intake of each is the primary treatment option. Methods of doing this include:[8]

  • Consuming more food rich in vitamin D and calcium, such as oily fish, cereals and eggs for vitamin D, and green leafy vegetables and dairy products for calcium.
  • Taking supplements containing vitamin D and calcium.
  • Receiving a vitamin D injection (usually administered yearly and, in most cases, only if other options are unavailable).
  • Increasing one’s exposure to sunlight.

Treatment for genetic forms of rickets will depend on the type. Hereditary hypophosphatemic rickets (the most common genetic form) typically requires phosphate and vitamin D supplements.

Supplement side-effects

It is rare for vitamin D or calcium supplements to cause any side-effects. However, if an incorrect dose of calcium is given, this can result in a condition known as hypercalcemia. Signs and symptoms include:[9]

  • Loss of appetite
  • Nausea and/or vomiting
  • Constipation
  • Abdominal pain
  • Thirstiness and an increased need to urinate
  • Fatigue and/or weakness
  • Muscle pain
  • Confusion
  • Headaches

If any of these signs or symptoms appear after starting a new supplement, medical attention should be sought without delay.


  1. NHS Choices. “Rickets and Osteomalacia.” December 21, 2015. Accessed November 23, 2017.

  2. You and Your Hormones. “Rickets.” December, 2014. Accessed November 23, 2017.

  3. NHS Choices. “Rickets and Osteomalacia: Symptoms.” December 21, 2015. Accessed November 23, 2017.

  4. NHS Choices. “Rickets and Osteomalacia: Causes.” December 21, 2015. Accessed November 23, 2017.

  5. The Royal Children’s Hospital Melbourne. “Rickets.” January, 2014. Accessed November 23, 2017.

  6. Genetics Home Reference. “Hereditary hypophosphatemic rickets.” November 21, 2017. Accessed November 23, 2017.

  7. You and Your Hormones. “Rickets.” December, 2014. Accessed November 23, 2017.

  8. NHS Choices. “Rickets and Osteomalacia: Treatment.” December 21, 2015. Accessed November 23, 2017.

  9. Cancer. “Hypercalcemia.” January, 2017. Accessed November 23, 2017. [10]: NHS Choices. “Rickets and Osteomalacia: Prevention.” December 21, 2015. Accessed November 23, 2017.