Medicines for Rickets and osteomalacia

What it is

Rickets and osteomalacia are conditions in which the bones become soft and weak because they are not properly mineralised (hardened) with calcium and phosphate. The same underlying problem is called rickets when it affects children (whose bones are still growing) and osteomalacia when it affects adults. The most common cause is a lack of vitamin D and/or calcium. Vitamin D is essential for the body to absorb calcium and keep the bones healthy; it is made in the skin through sunlight exposure and also comes from some foods and supplements. A lack of vitamin D can result from insufficient sunlight exposure (for example spending little time outdoors, covering the skin, having darker skin, or living in less sunny climates), a diet low in vitamin D and calcium, or, less commonly, from conditions affecting how the body absorbs or processes vitamin D, calcium, or phosphate. Certain groups are more at risk of vitamin D deficiency. In children, rickets can cause: soft, weak bones that may bend or bow (such as bowed legs or knock knees); pain, or reluctance to walk; delayed growth and development; bone deformities; dental problems; and an increased tendency to fractures. In adults, osteomalacia can cause: bone pain and tenderness (often in the hips, legs, ribs, or spine); muscle weakness (for example difficulty climbing stairs or getting up); a waddling walk; and an increased risk of fractures. Both conditions are usually treatable, and the encouraging point is that, in most cases (which are due to a lack of vitamin D or calcium), treatment with vitamin D and calcium corrects the problem, relieves symptoms, and allows the bones to heal, with children’s bone deformities often improving as they grow. The key messages are that rickets (in children) and osteomalacia (in adults) are softening of the bones usually caused by a lack of vitamin D or calcium, that they cause bone pain, weakness, and deformities, and that they are usually treatable with vitamin D and calcium, with prevention through adequate vitamin D.

How it is treated

Rickets and osteomalacia are usually treated by correcting the underlying lack of vitamin D and/or calcium, and by addressing any other cause; most cases respond well to treatment. If rickets or osteomalacia is suspected — from symptoms such as bone pain, muscle weakness, bone deformities (in children, such as bowed legs), or an increased tendency to fractures, particularly in those at risk of vitamin D deficiency — assessment is arranged, which includes blood tests (checking vitamin D, calcium, phosphate, and other markers) and sometimes X-rays, to confirm the diagnosis and identify the cause. For the common cause (a lack of vitamin D and/or calcium), treatment involves replacing them: vitamin D supplements (at an appropriate treatment dose, as advised) and ensuring adequate calcium intake (through diet and, if needed, supplements); with this, the symptoms usually improve and the bones heal over weeks to months, and in children, bone deformities often improve with growth, though some severe deformities may occasionally need further treatment. Sunlight exposure (safely) and a diet containing vitamin D and calcium support recovery and prevention. Where the cause is not simply dietary or sunlight-related — for example a condition affecting absorption or the processing of vitamin D, calcium, or phosphate, or a kidney or other underlying problem — this is identified and treated, sometimes with specialist input and specific forms of treatment. After treatment, ongoing adequate vitamin D and calcium help prevent recurrence. Prevention is important, particularly for those at higher risk of vitamin D deficiency: ensuring adequate vitamin D (through safe sunlight exposure, diet, and vitamin D supplements as recommended — supplements are advised for certain groups, such as young children, pregnant and breastfeeding women, and others at risk) helps prevent rickets and osteomalacia. The reassuring messages are that rickets and osteomalacia are usually caused by a treatable lack of vitamin D or calcium, that treatment with vitamin D and calcium usually corrects the problem and heals the bones, and that ensuring adequate vitamin D — particularly in at-risk groups — prevents them.