Rickets (children) or Osteomalacia (adults)

Question 1

Definition

Answer 1

Rickets is a condition where “softening” of the bones occurs, causing the bones to bend if they are weight-bearing

Vitamin D is required for normal Ca2+ ion absorption from the gut, and an absence of vitamin D leads to poor dietary calcium absorption, resulting in hypocalcaemia.
This in turn can lead to skeletal and dental deformities.

Exposure to sunlight causes human skin to naturally produce vitamin D, which enables Ca2+ to be absorbed but in the past, areas such as the Black Country suffered from severe air pollution that blocked sunlight, making childhood rickets a common problem. More recently, over-use of sunscreens has been shown to cause problems with natural vitamin D production.

Question 2

Lifestyle advise non pharm

Answer 2

Advice on safe sun exposure to help skin synthesis of vitamin D -
Darker skin need longer in the sun. Prolonged dont do anything extra.

Add VIT D to diet. Oily fish (salmon, mackerel), eggs, fortified margarine, fortified breakfast cereals.
Add calcium to diet. (Seeds, cheese, yoghurt, salmon, beans/lentils, almonds, etc)

Question 3

Prevention/Treatment

Answer 3

PREVENTION:
increase dietary intake of Vitamin D, or to increase exposure to sunlight = Oily fish (salmon, mackerel), eggs, fortified margarine, fortified breakfast cereals. Sunlight exposure in the UK is best at 11 am to 3 pm.

TREATMENT:
1ST LINE = Oral VIT D3 (Colecalciferol) active form
ALT = VIT D2 (Ergocalciferol) inactive form
Unwanted affect = hypercalcemia

If Rapid VIT D correction needed = potent antiresorptive agent (zoledronate, denosumab, or teriparatide), a fixed loading dose followed by regular maintenance vit D therapy 1 month after loading.
Loading dose = 300,000 of VIT D weekly or daily doses over 6 - 10 weeks.
Maintenance dose = VIT D = 800–2000 daily

Less urgent =
Can be started without loading dose.