Rickets is a disease of growing children that affects how the growth plates of bones develop. Rickets can cause bowing of the legs and bone pain. It can also increase a child’s risk of fracture (broken bone). Rickets is the softening and weakening of bones in children, usually Rare inherited problems also can cause rickets. Vitamin D helps your child's body absorb calcium and phosphorus from food<br />Sources and Metabolism of Vitamin D<br />Vitamin D plays an essential role in skeletal health by regulating normal blood levels of calcium and phosphorus There are 2 main forms of vitamin D vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D2 is primarily derived from plant sources. In addition to being present in foods such as fish, eggs, milk, and cod liver oil, the synthesis of vitamin D3 occurs naturally through the conversion of dehydrocholesterol to cholecalciferol in the skin by sunlight Vitamin D binds to the vitamin D binding protein and is transported to the liver for hydroxylation, and converted by 25-hydroxylase) into calcidiol (also known as hydroxyl-cholecalciferol, 25-hydroxyvitamin, calcifediol) which is then absorbed in the proximal tubule of the kidney and hydroxylated by the enzyme 1 alpha-hydroxylase to form the active metabolite of vitamin D, calcitriol (also known as 1,25-dihydroxy vitamin D).13 1,25-dihydroxy vitamin D acts on the vitamin D receptor in intestinal cells to increase the gut absorption of calcium by upregulating the calcium channel, there is a complex interaction between the hormones produced by the kidneys (1,25 dihydroxy vitamin D), bone (FGF-23), and PTH. Understanding these interactions is essential for proper management of ri <br />Severity of 25 (OH) vitamin D deficiency ( ng/m<br />Deficiency( <30) insufficiency (30-50) Adequat( >50 ) Toxicity( >250)<br />Types of Rickets<br />1-Nutritional Rickets– This is caused due to intake of food which lacks calcium, phosphorous and vitamin D.<br />2-Hypophosphatemic Rickets- It is caused due to low levels of phosphate. It is an X-linked genetic disorder where the kidneys are not able to control the amount of phosphate excreted in the urine.<br />3-Renal Rickets- People suffering from kidney disorders have renal rickets. They are unable to regulate the amount of calcium and phosphate excreted in the urine.<br />Symptoms Of Rickets<br />1-Reduced growth and short height 2-Fracture in bone 3-Softening of bones 4- pain in bones of arms, legs , pelvis and spine 5- Deformities in teeth 6- Deformities in the skeleton like bow leg ,and protruding breast bone<br />Predisposing factor for rickets:-<br />1-Darker Skin– excess melanin pigment<br />2-Inadequate supply of foods rich in calcium, phosphorous<br />3-Lack of sunlight exposure<br />4-When infants are breastfed without Vitamin D supplements<br />5-Possessing diseases which inhibit the absorption of Vitamin D<br />Diagnosis:-<br />1- Clinical examination of patient (signs and symptoms)<br />2- blood tests to measure the levels of calcium ,phosphate and parathyroid hormone in the blood <br />3- bone X-rays to check for bone deformities<br />4- Kidney function test <br />5- In rare cases, a bone biopsy will be performed. This involves the removal of a very small section of bone, which will be sent to a laboratory for analysis.<br />Management and Treatment<br />1-Diet changes. This usually involves high doses of vitamin D, from either diet or supplements. These doses may be given for several months, depending on the severity of the case and other factors.<br />2-Sunlight. Because your body can naturally make vitamin D when you’ve been exposed to sunlight, encouragement to get outside and get some sunshine is likely<br />3-Surgery. Usually, your child’s bones will straighten out on their own. For especially severe cases, children may need to wear braces to help correct the bending of their bones. In some cases, surgery may also be an option.<br /><br /><br />4-For inherited cases of rickets, there are several treatment options depending on the genetic disorder in question. Your pediatrician may refer you to see a specialist to help find a treatment solution.<br />د طالب جيجان طاهر اسنتشاري جراحة العظام والكسور<br />قسم تقنيات التخدير<br /><br /><br /><br /><br /><br />AL_mustaqbal University is the first university in Iraq<br /><br />