Skeletal pathology with infantile onset, the Rickets is an osteopathycaused by a defect in the mineralization of the bone matrix, which makes the bones more fragile and deformable. In an advanced stage it can be responsible for deformities and fractures. The etiopathogenesis is linked to the metabolism of vitamin D or calciferol. There are various forms of rickets, the most frequent is deficiency in which the insufficiency of the substance induces the reduction of intestinal calcium absorption. Hypocalcemia stimulates the production of parathyroid hormone which in turn reduces the renal excretion of the mineral and stimulates its mobilization from the bones, reducing its mineralization.
Causes of rickets
Rickets is an osteopathy caused by a defect in the mineralization of the bone matrix, the most frequent form is caused by vitamin D deficiency.
The disease is mainly caused by a deficiency of vitamin D which is approximately 90% formed in the skin, thanks to the action of the sun’s rays and the remaining 10% is absorbed through food.
This nutrient plays a fundamental role in the absorption of calcium and phosphorus and its deposition at bone level. Since a vitamin D deficiency can in turn cause a deficiency of calcium and phosphorus in the bones, growth and development disorders may occur.
In fact, rickets manifests itself with pain, reduced growth and the formation of weak bones that are unable to support the weight of the body and become subject to developing deformities.
Other forms are the Rickets due to impaired intake of vitamin D and the rickets due to chronic intestinal malabsorption.
Rickets can also be caused by a altered vitamin D metabolism both at the hepatic level, as in hepatobiliary diseases and secondary to chronic treatment with anticonvulsant drugs, and at the renal level. Rickets can also depend on a reduced action of vitamin D, in the absence of deficiency.
The onset of rickets can be favored by reduced exposure to the sunfrom vomiting and diarrhea prolonged periods and dietary deficits of calcium, magnesium and phosphorus. Today very rare in the West, the disease is epidemiologically very common in developing countries due to poor hygienic conditions and malnutrition.
Risk factors
Risk factors that predispose to rickets are:
Familiarity
- Dark skin that requires greater sun exposure to ensure adequate vitamin D synthesis
- Exclusive breastfeeding in countries with little sun exposure
- Being born in countries at high latitudes where sun exposure is reduced
Some pathologies, such as cystic fibrosiskidney disorders, celiac disease, inflammatory bowel diseases that interfere with the metabolism and absorption of calcium and vitamin D can promote rickets.
How rickets manifests itself
Il main symptom is the development of weak and excessively soft bones. There is therefore a softening of the bones. The pain exacerbated by movements makes the child reluctant to walk.
The symptoms are characterized by skeletal and dental alterations and muscular hypotonia. Teeth are fragile, grow slowly and are more prone to decay.
The first clinical signs manifest themselves with a weakening of the occipital and cranial parietal bones and an accentuation of the frontal bumps.
The so-called “ appearsstunted rosary”, i.e. an increase in the chondrocostal junctions. The chest is keeled, that is, projected forward and the Harrison’s groovea horizontal depression of the last coasts.
As we age, enlargements appear in the metaphyses of the long bones, in the wrists and ankles. Due to the increase in stress on the lower limbs, accentuated varus appears, i.e. the curvature of the diaphysis of the femurs, tibias and fibulas: the legs are bowed.
Diagnosis and treatment
Confirmation of the diagnosis comes from radiographic findings and blood tests which demonstrate characteristic alterations.
The therapeutic goal for the remission of rickets it is the rebalancing of vitamin D, calcium and phosphorus levels. Treatment is generally based onoral supplementation of calcium and vitamin D.
If left untreated in the growing child, skeletal deformities and short stature may become permanent. With proper treatment, the deformities improve or disappear over time. This metabolic condition can be prevented through a correct lifestyle, increasing exposure to sunlight and taking care of your diet.
Sitography
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