Rickets

Rickets is a childhood disorder that results in soft, weak and deformed bones due to inadequate mineralization during growth. Though it is most commonly seen in children, its root causes, vitamin D and calcium deficiency, have relevance throughout life, especially for bone health and disease prevention.

The condition is a reminder of how nutrient availability, sun exposure and lifestyle affect bone development and the risk of later-life conditions like osteoporosis.

What causes rickets

Rickets is typically caused by a lack of vitamin D, which the body needs to absorb calcium and phosphate from the gut. Without enough of these minerals, bones become soft and prone to deformities.

Main causes include:

• Insufficient sunlight exposure (which limits natural vitamin D production in the skin);
• Low dietary intake of vitamin D and calcium;
• Digestive issues like celiac disease or inflammatory bowel disease, which impair nutrient absorption;
• Chronic kidney or liver conditions, which disrupt vitamin D activation;
• Rare genetic conditions that affect phosphate metabolism.

Vitamin D deficiency is the most common underlying factor, especially in infants, toddlers and children living in areas with low sunlight.

Signs and symptoms of rickets

Symptoms may vary depending on severity but often include:

• Bowed legs (genu varum) or knock-knees (genu valgum);
• Delayed growth, short stature or delayed motor milestones;
• Widened wrists and ankles due to abnormal bone growth;
• Rib cage deformities or a soft skull;
• Bone pain, muscle weakness and dental problems;
• In severe cases, seizures or heart issues due to calcium imbalance.

Because early signs can be subtle, regular checkups are essential during rapid growth phases.

Diagnosis and who’s at risk

Rickets is typically diagnosed using:

• Blood tests to assess levels of calcium, phosphate, alkaline phosphatase and vitamin D;
• X-rays to reveal bone softening, deformities and growth plate abnormalities.

Children at higher risk include:

• Those with darker skin, which produces less vitamin D from sunlight;
• Infants exclusively breastfed without vitamin D supplementation;
• Children who spend little time outdoors;
• Those with digestive disorders or who follow restricted diets;
• Individuals with chronic illnesses affecting nutrient metabolism.

Even in modern societies, rickets can occur due to indoor lifestyles and poor diet.

How to prevent and treat rickets

Rickets is highly preventable with proper nutrition and lifestyle strategies:

Vitamin D

• Ensure adequate vitamin D through sun exposure, diet (e.g., fatty fish, eggs) or supplements;
• Breastfed infants typically need 400 IU/day of vitamin D supplementation;
• Supplementation is especially important in winter months or in areas with limited sun.

Calcium and phosphate

• Promote a diet rich in calcium (dairy, leafy greens, fortified foods) and phosphorus (nuts, legumes, whole grains);
• Support mineral absorption with magnesium and vitamin K2.

Medical support

• Treat underlying health conditions that affect nutrient absorption or metabolism;
• Monitor bone health in at-risk children through regular pediatric evaluations.

Public health efforts, including vitamin D fortification of foods and educational campaigns, have reduced the prevalence of rickets, but it remains a concern in vulnerable populations.

Rickets in the context of longevity and public health

While rickets is a condition of early life, it carries a powerful message for lifelong bone health:

• Early deficiencies can compromise long term skeletal integrity;
• Ensuring optimal bone development in childhood reduces the risk of osteoporosis in later decades;
• Highlights the importance of sunlight, nutrient density and functional mobility across the lifespan.

Bone strength is not just about avoiding fractures, it’s about maintaining the foundation for movement, independence and vitality as we age.

Rickets is more than a childhood disease, it’s a reflection of how vitamin D, calcium and lifestyle choices shape our skeletal foundation. Preventing it is simple but essential and the same strategies, sunlight, nutrient-rich diets and physical activity, support bone health at every age.

Understanding and addressing rickets helps protect not only growing children, but also ensures lifelong skeletal resilience for healthy aging.