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Vitamin D Deficiency Rickets – Causes, Risk Factors, Symptoms, Diagnosis, Treatment And Prophylaxis

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Vitamin D Deficiency Rickets

Vitamin D deficiency rickets is a common clinical manifestation of advanced vitamin D deficiencies, characterized by a disorder of bone mineralization, mainly encountered during growth. Daily need of vitamin D is 400-800 IU, with an average of 500 IU / day, regardless of age, depending on the growth, sun exposure and individual factors.

Vitamin D deficiency rickets occurs most frequently in the first two years of life but the disease can affect any period of childhood. In adults, in advanced forms of vitamin D deficiency, osteomalacia is installed. There are forms of rickets, where the genetic component is involved:

  • Vitamin-dependent rickets (Prader hereditary rickets).
  • Vitamin D resistant rickets (Albright hereditary rickets).
 Deficiency Rickets

Deficiency Rickets

Causes Of Vitamin D Deficiency Rickets

The main cause of  vitamin D deficiency rickets is represented by a insufficient intake of endogenous or exogenous vitamin D:

  • Absence of vitamin D prophylaxis.
  • Insufficient sun exposure or ineffective sun exposure due to pollution, season or skin pigmentation.
  • Nutritional deficiency of calcium and phosphorus (common in premature infants).
  • Nutritional deficiency of vitamin D.

Risk Factors Of Vitamin D Deficiency Rickets

  • Age 3-6 months – 2 years.
  • Prematurity.
  • Artificial feeding, without vitamin D supplementation.
  • Malnutrition, malabsorption.
  • Hypovitaminosis
  • Frequent infections, diarrhea.
  • Neonatal septicemia.
  • Intranatal trauma.
  • Corticotherapy for a long period.
  • Antiepileptic treatment.
  • Extrahepatic biliary atresia.
  • Abandoned, institutionalized children.
  • Kidney failure.
  • Pregnancy disorders.
  • Ecological factors.

Signs And Symptoms Of Vitamin D Deficiency Rickets

  • Manifestations of mild hypocalcemia events: anxiety, night sweats, unmotivated irritability, feeling of breathlessness, muscle cramps, numbness of extremities, feeling of lump in throat.
  • Palpitations, abdominal pain, bloating, loss of appetite, early satiety, asthenia, emotional volatility, reduced ability to concentrate.
  • Manifestations of sever hypocalcemia: seizures, muscle contractures, screaming for no apparent reason, glottis spasm, tremor, signs of intracranial hypertension (in newborns).
  • Delay of growth, short stature, bone changes, thickening of the extremities, thickening of the condro-costal joints, deformations of the chest (sternum out in relief, and distant lower ribs – pigeon breast), the appearance of Harrison subcostal groove, cranial deformation (asymmetric prominence of the frontal and parietal bose, occipital flattening) craniotabes – occipital bone softening, at palpation it has the consistency of a celluloid ball.
  • Fontanels are open after the age of  18 months or, sometimes, craniosynostosis.
  • Delayed appearance of the first incisors (after 10 months) or incomplete tooth eruption after 3 years.
  • The abdomen is relaxed due to the low muscle tone.
  • Liver and spleen are pushed down, due to chest deformity.
  • Limb deformities and bone fractures.
Symptoms Of Deficiency Rickets

Symptoms Of Deficiency Rickets

Diagnosis Of Vitamin D Deficiency Rickets

Diagnosis of vitamin D deficiency rickets is based on clinical examination and paraclinical investigations

Laboratory investigations

  • Low or normal serum calcium.
  • Phosphorus – low or normal.
  • Low elimination of calcium in the urine.
  • Increased alkaline phosphatase.
  • Increased phosphaturia.
  • Increased levels of parathyroid hormone.

Morphological changes

  • Demineralization of the skeleton.
  • Proliferation of osteoid tissue in the growth areas of the bones.

Special tests

  • Magnesium levels.
  • Total proteins levels.
  • Investigation of liver and kidney function.
 Deficiency Rickets

Deficiency Rickets

X-ray investigations

  • Radiography of the extremities:
  1. Enlargement of the epiphysis cartilage enlargement and irregular calcification of the metaphyseal extremity.
  2. Shaft head looks like a cup;
  3. Osteo-cartilaginous junction looks fringe, with a vague contour.
  • Chest radiography: anterior extremities of the ribs are enlarged.

Treatment And Prophylaxis Of Vitamin D Deficiency Rickets

General Measures

  • Exposure to sun at minimum 15 minutes a day.
  • Correct diet, rich in vitamin D, A, calcium and phosphorus.
  • Until the recovery of vitamin D deficiency rickets, will not be encouraged sitting position and walking of the baby, in order to prevent bone deformations.


  • Will be avoided the abuse of flour.
  • White fish, because is rich in vitamin D, which can be used after the age of 10-12 months, are indicated, in the absence of intolerance, milk, cream, egg yolk, liver, beef, veal or pork and butter.
  • Is required a high calcium and phosphorus intake (400-800 mg / day).
  • Foods rich in vitamin D: cod liver oil, cod liver and tuna liver, oysters, fish oil, egg yolk, liver and veal.
  • Diet will ensure adequate amounts of vitamin A and vitamin F.

Attention!!! Vitamin D is toxic in high doses.




Prophylaxis is based on vitamin D supplementation in the form of drugs.

  • Antenatal prophylaxis should be started by administration of vitamin D, 1000 – 1200 IU / day and calcium preparations in the last trimester of pregnancy.
  • Vitamin D supplementation will continue in the first days after birth, for 18-24 months continuously and then up to age of 5 years, during the cold seasons of the year.
  • 500 – 800 IU vitamin D daily.
  • 1000 -1500 IU vitamin D daily during the first months of life: in twins, in the absence of prenatal prophylaxis, in anticonvulsant therapy, in corticosteroids therapy and in other high-risk groups of children.
  • In premature newborns, in underweight newborns, 160 IU / kg / day of  vitamin D, daily is recommended. Premature infants are more susceptible to vitamin D deficiency rickets and require high doses of vitamin D, until the third quarter of life (period required for calcium stocks recovery).
  • In premature infants and infants who receive less than 400 ml of milk per day is required  addition of calcium, 50 mg / kg / day.