Rickets (cont.)

Signs and symptoms of rickets include bone pain or tenderness, dental deformities, delayed formation of teeth, decreased muscle strength, impaired growth, short stature, and a number of skeletal deformities, including abnormally shaped skull (craniotabes), bowlegs, rib-cage abnormalities (rachitic rosary), and breastbone, pelvic, and spinal deformities.

Occasionally, in very severe rickets, patients may develop even more serious signs and symptoms associated with very low levels of calcium or phosphate. These might include tetany (involuntary muscle contractions) or seizures. These are medical emergencies and require immediate treatment.

Rickets is initially diagnosed clinically with a complete medical and nutritional history and with a complete physical exam by a health professional. If rickets is suspected in a child and the child has no acute symptoms such as seizures or tetany, X-rays of long bones (radius, ulna, and femur) and ribs are obtained.

Vitamin D levels, alkaline phosphatase, parathyroid hormone (hormone involved in calcium and phosphate control), and electrolytes, including indirect measurements of kidney function (BUN and creatinine), should be evaluated if the X-rays show any of the following characteristics that are consistent with rickets:

• Widening or abnormally shaped metaphysis (most actively growing part of the bone below the growth plate)
• Obvious bowing of the femurs
• Osteopenia (bones which are not as dense, a sign of decreased mineralization)
• Rib flaring (rachitic rosary)
• Multiple fractures at different healing stages

Different causes of rickets will reveal different findings on laboratory tests. For the scope of this article, we will focus on vitamin D deficiency. In these cases, the active form of vitamin D will be decreased, parathyroid hormone will be increased, and calcium and phosphate will be decreased.

Source: MedicineNet.com
http://www.medicinenet.com/rickets/article.htm