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Rickets

Rickets is a disorder of the growing skeleton caused by defective mineralization of the growth plate and newly formed bone, most commonly due to vitamin D deficiency. It typically presents with skeletal deformities such as bow legs or knock knees, widened wrists, rachitic rosary, delayed growth, and muscle weakness. Treatment depends on the underlying cause and usually includes correction of vitamin D, calcium, phosphate, or metabolic abnormalities.

Rickets is a metabolic bone disorder of childhood characterized by defective mineralization of the growth plate cartilage and osteoid before epiphyseal closure. The commonest cause is nutritional vitamin D deficiency, although rickets may also result from calcium deficiency, phosphate wasting, renal disease, or inherited abnormalities of vitamin D metabolism. Children may present with growth retardation, bone pain, proximal muscle weakness, delayed motor milestones, and characteristic skeletal deformities. Common clinical findings include frontal bossing, craniotabes, widening of the wrists and ankles, rachitic rosary, Harrison sulcus, and lower-limb deformities such as genu varum or genu valgum. Radiographs typically show changes at rapidly growing metaphyses, especially around the wrist and knee, including physeal widening, metaphyseal cupping, fraying, and splaying, along with generalized osteopenia. Laboratory evaluation may include serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, vitamin D levels, and renal function depending on the suspected cause. Treatment is directed at the underlying abnormality. Nutritional rickets is treated with vitamin D and adequate calcium supplementation, while resistant forms may require phosphate replacement, active vitamin D analogues, or treatment of renal or genetic disease. Early treatment usually leads to healing of the growth plate and gradual correction of deformity. Persistent or severe angular deformities may occasionally require guided growth or corrective osteotomy after the metabolic abnormality has been adequately treated.

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