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Osteomalacia Content Supplied by NHS Choices
Introduction

Rickets is a condition that affects bone development in children. It causes the bones to become soft and weak, which can lead to bone deformities.

Rickets in adults is known as osteomalacia or soft bones.

The most common cause of rickets is a lack of vitamin D and calcium. Vitamin D largely comes from the exposure of the skin to sunlight, but it is also found in some foods such as oily fish and eggs. Vitamin D is essential for a child to form strong and healthy bones.

In rare cases, children can be born with a genetic form of rickets. It can also develop if another condition affects how vitamins and minerals are absorbed by the body.

Read more about the causes of rickets.

Who is affected

Rickets was common in the past, but it mostly disappeared in the Western world during the early twentieth century thanks to the fortification with vitamin D of foods such as margarine and cereal. However, there has been an increase in cases of rickets in the UK in recent years.

The number of rickets cases is still relatively small - less than 900 cases were diagnosed in hospitals in England during 2012 - but studies have shown that a significant number of people in the UK have low levels of vitamin D in their blood.

Any child whose diet does not contain enough vitamin D or calcium can develop rickets, but the condition is more common in children with dark skin (as this means more sunlight is needed to get enough vitamin D), children born prematurely, and children taking medication that interferes with vitamin D.

How to prevent rickets

Rickets can easily be prevented by eating a diet that includes vitamin D and calcium, as well as spending some time in sunlight.

The hands and face only need to be exposed to the sunlight for about 15 minutes a few times a week during spring and summer to provide you with enough vitamin D.

In some cases, vitamin D supplements may be recommended to reduce the risk of rickets.

Read more about preventing rickets, including information on good sources of vitamin D and calcium.

Signs and symptoms of rickets

Rickets can lead to bone pain, poor growth and deformities of the skeleton, such as bowed legs, curvature of the spine and thickening of the ankles, wrists and knees.

Children with rickets are also more likely to fracture their bones.

Read more about the symptoms of rickets.

When to seek medical advice

If your child has any symptoms of rickets, take them to your GP for a check-up.

Your GP will usually carry out a physical examination to check for any obvious problems. They may also discuss your child's medical history, diet, family history and any medication they are taking.

A blood test to measure calcium, phosphorous and vitamin D levels can usually confirm a diagnosis of rickets, although your child may also have some X-rays or possibly a bone density scan (DEXA scan). This is a special type of X-ray that measures the calcium content in the bones.

How rickets is treated

Rickets can be successfully treated in most children by ensuring they eat foods containing calcium and vitamin D or take vitamin supplements.

If your child has problems absorbing vitamins and minerals, they may need a higher supplement dose or a yearly vitamin D injection.

Read more about treating rickets.


Symptoms of rickets

Rickets causes a child's bones to become soft and weak, which can lead to bone deformities.

The signs and symptoms of rickets can include:

  • Fragile bones - the bones become weaker and more prone to fractures.
  • Poor growth and development - if the skeleton does not grow and develop properly, the child will be shorter than average.
  • Dental problems - including weak tooth enamel, delay in teeth coming through and increased risk of cavities.
  • Skeletal deformities - including soft skull bones, bowed legs, curvature of the spine and thickening of the ankles, wrists and knees. The breastbone can also stick out ('pigeon chest').
  • Pain - the bones affected by rickets can be sore and painful, so the child may be reluctant to walk or may tire easily. 

As your child gets older, the symptoms of rickets may also include waddling when walking, bent bones and muscle weakness or pain.

These symptoms can also affect adults who have soft bones (osteomalacia).

Some children with rickets may also have low levels of calcium in their blood (hypocalcaemia). This can make the symptoms of rickets worse and can also cause muscle cramps, twitching, tingling in the hands and feet, and fits.

When to seek medical advice

If your child has any symptoms of rickets, such as bone pain, delayed growth, muscle weakness or skeletal problems, take them to your GP for a check-up.


Treating rickets

Most cases of rickets are caused by a vitamin D and calcium deficiency. Therefore, rickets is usually treated by increasing a child's intake of vitamin D and calcium.

Vitamin D and calcium levels can be increased by:

  • eating more foods rich in calcium and vitamin D
  • taking daily calcium and vitamin D supplements
  • having a vitamin D injection each year (this is only necessary if the child cannot take the supplements by mouth or has intestinal or liver disease)

Sunlight also contains vitamin D, so you may be advised to increase the amount of time your child spends outside.

Your GP will advise you about how much vitamin D and calcium your child will need to take. This will depend on their age and the cause of the rickets. If your child has problems absorbing vitamins, they may need a higher dose.

See preventing rickets for more information about dietary sources of vitamin D and calcium, as well as advice about getting vitamin D from sunlight.

Treating complications and related conditions

When rickets occurs as a complication of another medical condition, treating the underlying condition will often cure the rickets. For example, people who have kidney disease and rickets may require dialysis (treatment that replicates many of the kidneys' functions).

If your child has a bone deformity caused by rickets, such as bowed legs or curvature of the spine, your GP may suggest treatment to correct it. This might be a brace to support the affected area of your child's body as their bones grow, or they may need surgery.

Genetic rickets

For hypophosphatemic rickets (where a genetic defect causes abnormalities in the way the kidneys and bones deal with phosphate), a combination of phosphate supplements and a special form of vitamin D is required.

Children with other types of genetic rickets need very large amounts of a special type of vitamin D treatment.

Supplement side effects

It is very unusual to get side effects from vitamin D, calcium or phosphate supplements if they are given in the correct dose.

However, if the dose of vitamin D or calcium is too high, it can raise calcium levels in the blood. This can result in a condition called hypercalcaemia. Symptoms of hypercalcaemia include:

See your GP immediately if you or your child has any of these symptoms.


 
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