Rickets- brief view

with homoeopatic
approach

Presented By: Dr. SANDEEP ANWANE

Govt. Homoeo. Medical College, Bhopal
 Alternative Names:

 Osteomalacia in children; Vitamin D

deficiency; Renal rickets
 Definition:

 Rickets is a constitutional disease of infancy

and childhood, characterized by impairment of
the general health, arrested growth, abnormal
proliferation of classification of the developing
bone.
 Rickets is a disorder primarily caused by lack
of vitamin D, calcium, or phosphate, which
leads to softening and weakening of the bones.
 Causes:
 The most common cause of osteomalacia is a
deficiency of vitamin D. Vitamin D
insufficiency can cause osteomalacia because
vitamin D facilitates calcium absorption and
other minerals in the gastrointestinal tract
necessary for bone building. Lack of vitamin
D, calcium and other minerals aren’t absorbed
efficiently, so they are not available for
mineralization in the bone building process.
This then result in soft bones.
 Insufficient sunlight exposure - Sunlight
makes vitamin D in your skin. Therefore
osteomalacia can develop in people who spend
little time in the sunlight, wear very strong
sunscreen, live in areas where sunlight hours
are short, or where the air is smoggy.
 Insufficient vitamin D intake -A diet low in
vitamin D is the most common cause seen
worldwide. Is less common in the U.S.
because many foods, such as milk and cereals
are fortified with vitamin D.
 Certain Surgeries - The removal of part or all of
your stomach known as gastrectomy, can lead to this
disease because the stomach breaks down foods to
release vitamin D and other materials, which are then
absorbed by your intestines. Surgery removing or
bypassing your small intestine can lead to
osteomalacia.
 Chronic pancreatitis - Pancreatitis is the long-
standing inflammation of your pancreas, an organ that
makes digestive enzymes and hormones. If the
pancreas is inflamed enzymes in charge of breaking
down food and releasing nutrients do not flow as
freely into your intestines.
 Chronic sprue - In this autoimmune disorder,
the lining of the small intestine is damaged by
consuming foods having gluten, a protein
found in wheat, barley, and rye. Damaged
intestinal lining doesn’t absorb nutrients, such
as vitamin D, as well as a healthy one would.
 Mechanism of Vitamin –D:
 The National Institutes of Health has stated
that the following amounts of total calcium
intake per day are useful to prevent rickets:
400 mg until six months of age
600 mg from six to twelve months
800 mg from one year through age five
800–1,200 mg from age six until age ten
 Vitamin D helps the body properly control calcium
and phosphate levels in the body. When the body is
deficient in vitamin D, it is unable to properly control
calcium and phosphate levels. If the blood levels of
these minerals become too low, the body may
produce other body hormones to stimulate release of
calcium and phosphate from the bones. This leads to
weak and soft bones.
 Vitamin D may be absorbed from food or may be
produced by the skin when the skin is exposed to
sunlight. Lack of vitamin D production by the skin
may occur in people who must stay indoors, work
indoors during the daylight hours, or live in climates
with little exposure to sunlight.
 Because vitamin D is a fat-soluble vitamin,
malabsorption disorders that reduce digestion
or absorption of fats will decrease the ability
of vitamin D to be absorbed into the body.
 You may not get enough Vitamin D from your
diet if you follow a vegetarian diet, do not
drink milk products, or are lactose intolerant
(have trouble digesting milk products). Infants
who are exclusively breastfed may develop
vitamin D deficiency. Human breast mil does
not supply the proper amount of vitamin D.
This can be a particular problem for darker-
skinned children in winter months (when there
are lower levels of sunlight).
 Not getting enough calcium and phosphorous
in your diet can also lead to rickets. Rickets
caused by a dietary lack of these minerals is
rare in developed countries because calcium
and phosphorous are found in milk and green
vegetables.
 Risk Factor:
Those at higher risk for developing rickets
include:
• Breast-fed infants whose mothers are not
exposed to sunlight
• Breast-fed infants who are not exposed to
sunlight
• Individuals not consuming fortified milk, such
as those who are lactose intolerant
• Individuals with red hair have been speculated
to have a decreased risk for rickets due to their
greater production of vitamin D in sunlight.
• Your genes may increase your risk of rickets.
Hereditary rickets is form of the disease that is
passed down through families. It occurs when
the kidneys are unable to retain the mineral
phosphate. Rickets may also be caused by
kidney disorders that involve renal tubular
acidosis.
 Occasionally, rickets may also occur in
children who have disorders of the liver, or
cannot convert vitamin D to its active form.
 Incidence and Prevalance:
 In the United States it is estimated that 20 to 25
million people suffer from osteomalacia, including 25
percent of women beyond menopause
 Incidence of 1 per 1000 people in the United States
 Rickets: In the U.S., severe nutritional rickets has
become rare, although the mild disorder continues in
the high-risk population (eg, individuals with dark
skin, persons who live in inner-city areas). Breastfed
infants who receive no vitamin D supplementation
also are at risk.
 Rickets: Incidence in Europe is similar to that
in the U.S. In sunny areas, such as in the
Middle East, rickets may occur when infants
are bundled in clothing and are not exposed to
sunlight. In some parts of Africa, deficiency of
calcium and/or phosphorous in the diet may
lead to rickets.
 Rickets is rare in the United States. It is most
likely to occur during periods of rapid growth,
when the body demands high levels of calcium
and phosphate. Rickets may be seen in young
children 6 to 24 months old and is uncommon
in newborns.
 Signs and Symptoms:
• Bone pain or tenderness
Arms
Legs
Spine
Pelvis
• Skeletal deformities
Bowlegs
Forward projection of the breastbone (pigeon chest)
Bumps in the rib cage (rachitic rosary)
Asymmetrical or odd-shaped skull
Spine deformities (spine curves abnormally, including
scoliosis or kyphosis)
Pelvic deformities
• Increased tendency toward bone fractures
• Dental deformities
Delayed formation of teeth
Defects in the structure of teeth, holes in the
enamel
Increased incidence of cavities in the teeth
(dental caries)
Progressive weakness
Decreased muscle tone (loss of muscle strength)
• Muscle cramps
• Impaired growth
• Short stature (adults less than 5 feet tall)
 Exams and Tests:
A physical exam reveals tenderness or pain in the bones,
rather than in the joints or muscles.
 The following tests may help diagnose rickets:
Blood tests (serum calcium) may show low levels of
calcium.
Tetany (prolonged muscle spasm) may occur if serum
levels of calcium are low.
Chvostek's sign may be positive (a spasm of facial
muscles occurs when the facial nerve is tapped)
indicating low serum levels of calcium.
Serum phosphorus may be low.
Serum alkaline phosphatase may be high.
 Arterial blood gases may reveal metabolic
acidosis.
 Bone x-rays may show loss of calcium from
bones or changes in the shape or structure of
the bones.
 A bone biopsy is rarely performed but will
confirm rickets.
Other tests and procedures include
the following:
• PTH
• Urine calcium
• Calcium (ionized)
• ALP (alkaline phosphatase) isoenzyme
 Treatment:
 The treatment goals are to relieve symptoms and
correct the cause of the condition. The underlying
cause must be treated to prevent recurrence.
 The symptoms disappear with the replacement of
deficient calcium, phosphorous, and/or vitamin D.
 Biologically active form of vitamin D could be used
in people who have difficulty in converting vitamin D
to its active form. Including fish, liver and processed
milk, which are rich sources of vitamin D in the diet.
 Exposure to moderate amounts of sunlight.
 Skeletal deformities could be corrected by
maintaining a good posture and bracing could help in
reducing the deformities.
 Outlook (Prognosis):
 The disorder may be corrected with
replacement of deficient minerals and vitamin
D. Laboratory values and x-rays usually
improve after about 1 week, although some
cases may be resistant and require large doses
of minerals and vitamin D.
 If rickets is not corrected while children are
still growing, skeletal deformities and short
stature may be permanent. If it is corrected
while the child is young, skeletal deformities
often diminish or disappear with time.
 Possible Complications:

• Chronic skeletal pain

• Skeletal deformities
• Skeletal fractures, may occur without cause
 Prevention:
 Osteomalacia caused by inadequate sun exposure and
a diet low in vitamin D can be prevented.
 Spend a few minutes in the sun Direct exposure in the
sun to the arms and legs for five to ten minutes daily
is sufficient for adequate vitamin D production. If a
person lives in cold climate and don’t get enough sun
exposure during the winter, they can build enough
vitamin D stores in the skin during warmer months.
Although regular use of sunscreen helps prevent skin
cancer and premature aging of the skin, there is
concern that the frequent use of strong sunscreen can
increase the risk of developing ostemalacia.
 Spend a few minutes in the sun Direct exposure in the
sun to the arms and legs for five to ten minutes daily
is sufficient for adequate vitamin D production. If a
person lives in cold climate and don’t get enough sun
exposure during the winter, they can build enough
vitamin D stores in the skin during warmer months.
Although regular use of sunscreen helps prevent skin
cancer and premature aging of the skin, there is
concern that the frequent use of strong sunscreen can
increase the risk of developing ostemalacia.
 Take supplements If a person doesn’t get enough
vitamins and minerals in their diet or if they have a
medical condition affecting the ability of their
digestive system to absorbing nutrients, they are
recommended to ask a doctor about taking vitamin D
and calcium supplements.
 Exercise Exercise such as walking helps
strengthen bones, but if a patient has slight
fractures due to osteomalacia, they should
avoid strenuous activity until their bones heal.
 Renal (kidney) causes of vitamin D
malabsorption should be treated promptly.
Levels of calcium and phosphorus should be
monitored regularly in people who have renal
disorders.
 Genetic counseling may help people with a
family history of inherited disorders that can
cause rickets.
 Homoeopathic Treatment:
 Calcarea phos
In delicate children, caused by soft sponginess of the
bone, from want of phosphate of lime molecules.
Skull soft and thin, with crackling noise when pressed
upon, delayed closure of fontanelles, sallow, earthy
complexion, face pimpled, retarded dentition,
emaciation, lateral curvature, swollen condyles in
both extremities, spina bifida, non-union of broken
bones, systematic dyscrasias. Potts\' disease, shrunken
children, hard lumps on the cranium, diarrhoea during
dentition with much flatus, cold tremors, child cannot
hold head upright. Its principal indications are the
fontanelles which remain wide open, the diarrhoea
and the emaciation of the child.
Kali phos
Atrophy of the bones, with putrid-smelling discharge
from the bowels. Indigestion with nervous
depression.

Natrum mur
Particularly useful when the thighs are notably
emaciated and the disease is in its early stages, with
slight pliability of the bones. (Gilchrist.)
 Silicea
Open fontanelles, head too large and rest of body
emaciated, with pale face, abdomen swollen, hot;
ankles weak, profuse head sweat and body dry, likes
wrapping up warmly, offensive diarrhoea, stools
contain undigested food, with great exhaustion, but
painless; inflammation, swelling and suppuration of
glands and bones, ulceration and necrosis, cellular
inflammation, boils. Abscess, etc., with tardy
recovery and subsequent induration.
 Thanks
For patience
Ear