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A case study of nutritional rickets

Nutritional rickets remains a public health problem in many countries despite dramatic declines in the prevalence of the condition in many developed countries since the discoveries of vitamin D and the role of ultraviolet light in prevention.

The disease continues to be problematic among infants in many communities. A child with rickets can present in so many ways; generalized weakness, thinning and softening of the skull bones known in medical parlance as craniotabes.

Classically, the bone feels like “table tennis or ping pong ball”. Older children with rickets present with thickening of the skull bones, delayed closure of the soft part of the infant head called the anterior fontanelle.

There is spreading of the ends of the long bones forming knobs at the ends because of weak bone formation. Weight-bearing on these bones in the lower limbs leads to bowlegs and knock-knees.

In the chest, a knobby deformity at the ribs leads to rounded edges that tend to be in line when viewed from up to down called a rachitic rosary.  The sternum can also be pulled into a pigeon- breast deformity.

In more severe instances, the softening of the bones in the back can lead to posture deformity with the curving of the bones of the back.  Other symptoms of rickets include pain or tenderness in the bones of the limbs and spine, stunted growth or short stature, teeth deformities including delayed tooth formation and holes in the teeth.

In investigating a child with rickets, an assay of the minerals involved in bone formation and strengthening such as calcium and phosphates are done. Also, an enzyme that is involved in the mobilization of calcium from the bones called alkaline phosphates as well as the vitamin D levels in the blood is done and analyzed.

Serum parathyroid, kidney function tests is also done to ascertain the possible cause of rickets. An x-ray of the hands and feet can show thinning and fraying of the bones, widened joint space, destroyed bone ends.

Treatment for rickets focuses on replacing the deficient minerals in the body. Most of the symptoms are eliminated with the replacement of the minerals. Foods rich in vitamin D and calcium are encouraged. In severe cases, vitamin D and calcium preparation are given to boost calcium absorption and good bone formation.

If skeletal deformities are present, the child will need to see an orthopedic surgeon. Serial x-rays to monitor the angles of deformities are done to ascertain whether self-correction is likely or not.

Braces to help position the bones correctly as the child grows is another treatment option for those with limb deformities that don’t seem to correct itself. In some cases, corrective surgery is done.

Braces to help position the bones correctly as the child grows is another treatment option for those with limb deformities that don’t seem to correct itself. In some cases, corrective surgery is done.

With early recognition and treatment modalities put in place, complications of rickets can be avoided. Treatment may need to be continued for a longer period and repeat blood tests to ascertain the improvement of bone mineralization.

There may be the need to adjust the dosage of vitamin D and calcium based on the results of these investigations.

Story by Albert Egoh

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