Editing Rickets

{{Short description|Childhood bone disorder as shown by}}
{{Distinguish|rickettsia|osteogenesis imperfecta}}
{{For|the surname|Ricketts (disambiguation){{!}}Ricketts}}
{{Use dmy dates|date=November 2020}}
{{Infobox medical condition
| name            = Rickets
| pronounce  = {{IPAc-en|ˈ|r|ɪ|k|ᵻ|t|s}}
| image           = XrayRicketsLegssmall.jpg
| caption         = [[Radiograph|X-ray]] of a two-year-old with ricket, with a marked maeve [[genu varum|bowing of the femur]]s and decreased [[bone density]]
| field           = [[Pediatrics]], [[rheumatology]], [[dietetics]]
| symptoms        = [[Bowed legs]], [[stunted growth]], bone pain, large forehead, trouble sleeping<ref>{{cite journal | vauthors = Elder CJ, Bishop NJ | title = Rickets | journal = Lancet | volume = 383 | issue = 9929 | pages = 1665–1676 | date = May 2014 | pmid = 24412049 | doi = 10.1016/S0140-6736(13)61650-5 | s2cid = 208788707 }}</ref><ref name=NIH2013/><ref name=NORD2005>{{cite web|title=Rickets, Vitamin D Deficiency|url=https://rarediseases.org/rare-diseases/rickets-vitamin-d-deficiency/|publisher=NORD (National Organization for Rare Disorders)|access-date=19 December 2017|date=2005}}</ref>
| complications   = [[Bone fractures]], [[muscle spasms]], [[scoliosis|abnormally curved spine]], [[intellectual disability]]<ref name=NORD2005/>
| onset           = Childhood<ref name=NORD2005/>
| duration        =
| types           =
| causes          = Diet without enough [[vitamin D]] or [[calcium]], too little sun exposure, exclusive [[breastfeeding]] without supplementation, [[celiac disease]], certain [[genetic condition]]s<ref name=NIH2013/><ref name=NORD2005/><ref name=Cre2017/>
| risks           =
| diagnosis       = [[Blood tests]], [[Radiographs|X-rays]]<ref name=NIH2013/>
| differential    = [[Fanconi syndrome]], [[scurvy]], [[Lowe syndrome]], [[osteomalacia]]<ref name=NORD2005/>
| prevention      = Vitamin D supplements for exclusively-breastfed babies<ref name=AO2010/>
| treatment       = [[Vitamin D]] and [[calcium]]<ref name=NIH2013/>
| medication      =
| prognosis       =
| frequency       = Relatively common ([[Middle East]], Africa, Asia)<ref name=Cre2017/>
| deaths          =
}}

<!-- Definition and symptoms -->
'''Rickets,''' scientific nomenclature: rachitis (from Greek {{Lang|grc|ῥαχίτης}} {{translit|grc|rhakhítēs}},<ref name=":0">{{cite web| url = https://www.perseus.tufts.edu/hopper/morph?l=raxiths&la=greek#lexicon | title = ῥαχίτης | trans-title = ῥachitis | language = Greek | work = Greek Word Study Tool}}</ref> meaning 'in or of the spine'), is a condition that results in weak or soft [[bone]]s in children and may have either dietary deficiency or genetic causes.<ref name=NIH2013>{{cite web|title=Rickets|url=https://rarediseases.info.nih.gov/diseases/5700/rickets|website=Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|access-date=19 December 2017|language=en|date=2013}}</ref> Symptoms include [[bowed legs]], [[stunted growth]], bone pain, large [[forehead]], and trouble sleeping.<ref name=NIH2013/><ref name=NORD2005/> Complications may include bone [[Deformity|deformities]], bone [[pseudofracture]]s and [[Bone fracture|fractures]], [[muscle spasms]], or an [[scoliosis|abnormally curved spine]].<ref name=NIH2013/><ref name=NORD2005/> The analogous condition in adults is [[osteomalacia]].

<!-- Cause and diagnosis -->
The most common cause of rickets is a [[hypovitaminosis D|vitamin D deficiency]], although hereditary genetic forms also exist.<ref name=NIH2013/> This can result from eating a diet without enough [[vitamin D]], dark skin, too little sun exposure, exclusive [[breastfeeding]] without vitamin D supplementation, [[celiac disease]], and certain [[genetic condition]]s.<ref name=NIH2013/><ref name=NORD2005/> Other factors may include not enough [[calcium]] or [[phosphorus]].<ref name=Cre2017>{{cite journal | vauthors = Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR | title = Nutritional rickets around the world: an update | journal = Paediatrics and International Child Health | volume = 37 | issue = 2 | pages = 84–98 | date = May 2017 | pmid = 27922335 | doi = 10.1080/20469047.2016.1248170 | s2cid = 6146424 }}</ref><ref name=AO2010>{{cite web|title=Rickets - OrthoInfo - AAOS|url=https://orthoinfo.aaos.org/en/diseases--conditions/rickets/|access-date=19 December 2017|date=September 2010}}</ref> The underlying mechanism involves insufficient [[calcification]] of the [[growth plate]].<ref>{{cite book| vauthors = Florin T, Ludwig S, Aronson PL, Werner HC |title=Netter's Pediatrics E-Book|date=2011|publisher=Elsevier Health Sciences|isbn=978-1455710645|page=430|url=https://books.google.com/books?id=7czRAQAAQBAJ&pg=PA430|language=en}}</ref> Diagnosis is generally based on [[blood tests]] finding a [[hypocalcemia|low calcium]], [[hypophosphatemia|low phosphorus]], and a high [[alkaline phosphatase]] together with [[radiographs|X-rays]].<ref name=NIH2013/>

<!-- Prevention and treatment -->
Prevention for exclusively breastfed babies is vitamin D supplements.<ref name=AO2010/> Otherwise, treatment depends on the underlying cause.<ref name=NIH2013/> If due to a lack of vitamin D, treatment is usually with vitamin D and calcium.<ref name=NIH2013/> This generally results in improvements within a few weeks.<ref name=NIH2013/> Bone deformities may also improve over time.<ref name=AO2010/> Occasionally surgery may be performed to correct bone deformities.<ref name=JAAOSGlobal>{{cite journal | vauthors = El-Sobky TA, Samir S, Baraka MM, Fayyad TA, Mahran MA, Aly AS, Amen J, Mahmoud S | display-authors = 6 | title = Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm | journal = Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews | volume = 4 | issue = 1 | pages = e19.00009 | date = January 2020 | pmid = 32159063 | pmc = 7028784 | doi = 10.5435/JAAOSGlobal-D-19-00009 | doi-access = free }}</ref><ref name=NORD2005/> Genetic forms of the disease typically require specialized treatment.<ref name=AO2010/>

<!-- Epidemiology and history -->
Rickets occurs relatively commonly in the [[Middle East]], [[Africa]], and [[Asia]].<ref name=Cre2017/><!-- Quote = Rickets remains a significant health problem in Africa, particularly West Africa... In Qatar and other countries of the Arabian Peninsula region, vitamin D deficiency and nutritional rickets remain public health problems owing to a lack of routine vitamin D supplementation... In China, particularly in rural areas, rickets remains a major public health problem.  --> It is generally uncommon in the United States and Europe, except among certain [[minority group]]s<ref name=NORD2005/><ref name=Cre2017/> but rates have been increasing among some populations.<ref name=aap01/> It begins in childhood, typically between the ages of 3 and 18 months old.<ref name=NORD2005>{{cite web|title=Rickets, Vitamin D Deficiency|url=https://rarediseases.org/rare-diseases/rickets-vitamin-d-deficiency/|publisher=NORD (National Organization for Rare Disorders)|access-date=19 December 2017|date=2005}}</ref><ref name=Cre2017/> Rates of disease are equal in males and females.<ref name=NORD2005/> Cases of what is believed to have been rickets have been described since the 1st century,<ref name="History"/> and the condition was widespread in the [[Roman Empire]].<ref>{{Cite web|url=https://www.theguardian.com/science/2018/aug/20/roman-rickets-vitamin-d-deficiency|title=Evidence in the bones reveals rickets in Roman times| vauthors = Brown M |date=2018-08-19|website=The Guardian|language=en|access-date=2018-08-20}}</ref> The disease was common into the 20th century.<ref name="History">{{cite journal | vauthors = Rajakumar K | title = Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective | journal = Pediatrics | volume = 112 | issue = 2 | pages = e132–e135 | date = August 2003 | pmid = 12897318 | doi = 10.1542/peds.112.2.e132 | doi-access = free }}</ref> Early treatments included the use of [[cod liver oil]].<ref name="History"/><ref name="Rosita">{{cite web |url=https://www.rositausa.com/pages/history |title=Cod Liver Oil: History |last= |first= |date= |website=Rosita |access-date=5 December 2024}}</ref><ref name="Hernigou2019">{{cite journal |vauthors=Hernigou P, Auregan JC, Dubory A |title=Vitamin D: part II; cod liver oil, ultraviolet radiation, and eradication of rickets |journal=Int Orthop |volume=43 |issue=3 |pages=735–49 |date=March 2019 |pmid=30627846 |doi=10.1007/s00264-019-04288-z |url=}}</ref>

== Signs and symptoms ==
[[File:Rickets wrist.jpg|thumb|upright=1.3|Widening of wrist]] 
Signs and symptoms of dietary deficiency rickets can include [[bone]] tenderness, and a susceptibility for bone [[fracture]]s, particularly [[greenstick fracture]]s.<ref name="MedicalNews">{{cite web| url = http://www.news-medical.net/health/Rickets-Symptoms.aspx| title = Medical News – Symptoms of Rickets| date = March 2010}}</ref> Early skeletal deformities can arise in infants such as soft, thinned skull bones – a condition known as [[craniotabes]],<ref>{{cite journal | vauthors = Harvey NC, Holroyd C, Ntani G, Javaid K, Cooper P, Moon R, Cole Z, Tinati T, Godfrey K, Dennison E, Bishop NJ, Baird J, Cooper C | display-authors = 6 | title = Vitamin D supplementation in pregnancy: a systematic review | journal = Health Technology Assessment | volume = 18 | issue = 45 | pages = 1–190 | date = July 2014 | pmid = 25025896 | pmc = 4124722 | doi = 10.3310/hta18450 }}</ref><ref>{{cite journal | vauthors = Prentice A | title = Nutritional rickets around the world | journal = The Journal of Steroid Biochemistry and Molecular Biology | volume = 136 | pages = 201–206 | date = July 2013 | pmid = 23220549 | doi = 10.1016/j.jsbmb.2012.11.018 | s2cid = 19944113 }}</ref> which is the first sign of rickets; [[skull bossing]] may be present and a delayed closure of the [[fontanelle]]s.

Young children may have [[Genu varum|bowed legs]] and thickened ankles and wrists;<ref>{{cite web| url = maeve http://www.mayoclinic.com/health/rickets/DS00813/DSECTION=symptoms| work = Mayo Clinic | title = Signs and Symptoms of Rickets}}</ref> older children may have [[knock knees]].<ref name="MedicalNews"/> [[Vertebral column|Spinal curvatures]] of [[kyphoscoliosis]] or lumbar [[lordosis]] may be present. The [[pelvic bone]]s may be deformed. A condition known as [[rachitic rosary]] can result as the thickening caused by nodules forming on the [[costochondral joint]]s. This appears as a visible bump in the middle of each rib in a line on each side of the body. This somewhat resembles a rosary, giving rise to its name. The deformity of a pigeon chest<ref name="MedicalNews"/> may result in the presence of [[Harrison's groove]].

[[Hypocalcemia]], a low level of calcium in the blood can result in [[tetany]] – uncontrolled muscle spasms. Dental problems can also arise.<ref name="MedicalNews"/>

An [[X-ray]] or [[radiography|radiograph]] of an advanced patient with rickets tends to present in a classic way: the bowed legs (outward curve of long bone of the legs) and a deformed chest. Changes in the skull also occur causing a distinctive "square headed" appearance known as "caput quadratum".<ref>{{cite web|title=caput quadratum|url=http://medical-dictionary.thefreedictionary.com/caput+quadratum|website=TheFreeDictionary.com}}</ref> These deformities persist into adult life if not treated. Long-term consequences include permanent curvatures or disfiguration of the long bones, and a [[Scoliosis|curved back]].<ref name=":1">{{cite journal | vauthors = O'Riordan JL, Bijvoet OL | title = Rickets before the discovery of vitamin D | journal = BoneKEy Reports | volume = 3 | pages = 478 | date = January 2014 | pmid = 24466409 | pmc = 3899557 | doi = 10.1038/bonekey.2013.212 }}</ref>

==Cause==
Maternal deficiencies may be the cause of overt bone disease from before birth and impairment of bone quality after birth.<ref name=Elidrissy2016>{{cite journal | vauthors = Elidrissy AT | title = The Return of Congenital Rickets, Are We Missing Occult Cases? | journal = Calcified Tissue International | volume = 99 | issue = 3 | pages = 227–236 | date = September 2016 | pmid = 27245342 | doi = 10.1007/s00223-016-0146-2 | type = Review | s2cid = 14727399 }}</ref><ref name=PatersonAyoub2016>{{cite journal | vauthors = Paterson CR, Ayoub D | title = Congenital rickets due to vitamin D deficiency in the mothers | journal = Clinical Nutrition | volume = 34 | issue = 5 | pages = 793–798 | date = October 2015 | pmid = 25552383 | doi = 10.1016/j.clnu.2014.12.006 | type = Review }}</ref> The primary cause of congenital rickets is [[vitamin D deficiency]] in the mother's blood.<ref name=PatersonAyoub2016 /> Vitamin D ensures that serum phosphate and calcium levels are sufficient to facilitate the mineralization of bone.<ref>{{Cite web | url=https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ | title=Office of Dietary Supplements - Vitamin D}}</ref> Congenital rickets may also be caused by other maternal diseases, including severe [[osteomalacia]], untreated [[celiac disease]], [[malabsorption]], [[pre-eclampsia]], and [[Preterm birth|premature birth]].<ref name=Elidrissy2016 /> Rickets in children is similar to osteoporosis in the elderly, with brittle bones. Pre-natal care includes checking vitamin levels and ensuring that any deficiencies are supplemented.<ref>{{Cite web | url=http://www.webmd.com/baby/guide/prenatal-vitamins#1 | title=Pregnancy and prenatal vitamins}}</ref>

Exclusively breast-fed infants may require rickets prevention by vitamin D supplementation or an increased exposure to sunlight.<ref name="pmid18497439">{{cite journal | vauthors = Balasubramanian S, Ganesh R | title = Vitamin D deficiency in exclusively breast-fed infants | journal = The Indian Journal of Medical Research | volume = 127 | issue = 3 | pages = 250–255 | date = March 2008 | pmid = 18497439 | type = Review }}</ref>

In sunny countries such as Nigeria, South Africa, and Bangladesh, there is sufficient endogenous vitamin D due to exposure to the sun. However, the disease occurs among older toddlers and children in these countries, which in these circumstances is attributed to low dietary calcium intakes due to a mainly cereal-based diet.<ref name="pmid15585795">{{cite journal | vauthors = Pettifor JM | title = Nutritional rickets: deficiency of vitamin D, calcium, or both? | journal = The American Journal of Clinical Nutrition | volume = 80 | issue = 6 Suppl | pages = 1725S–1729S | date = December 2004 | pmid = 15585795 | doi = 10.1093/ajcn/80.6.1725S | type = Review | doi-access = free }}</ref>

Those at higher risk for developing rickets include:
* [[Breastfeeding|Breast-fed]] infants whose mothers are not exposed to sunlight
* Breast-fed infants who are not exposed to sunlight
* Breast-fed babies who are exposed to little sunlight
* Adolescents, in particular when undergoing the [[Adolescence#Growth spurt|pubertal growth spurt]]<ref name="pmid24818008">{{cite journal | vauthors = Glorieux FH, Pettifor JM | title = Vitamin D/dietary calcium deficiency rickets and pseudo-vitamin D deficiency rickets | journal = BoneKEy Reports | volume = 3 | pages = 524 | year = 2014 | pmid = 24818008 | pmc = 4015456 | doi = 10.1038/bonekey.2014.19 | type = Review }}</ref>
* Any child whose diet does not contain enough vitamin D or calcium

Diseases causing soft bones in infants, like [[hypophosphatasia]] or [[hypophosphatemia]], can also lead to rickets.<ref>{{cite web|title=Hypophosphatasia: Signs and Symptoms|url=http://hypophosphatasia.com/what-hypophosphatasia/signs-and-symptoms|website=Hypophosphatasia.com|access-date=10 September 2014|archive-date=15 October 2014|archive-url=https://web.archive.org/web/20141015143435/http://www.hypophosphatasia.com/what-hypophosphatasia/signs-and-symptoms|url-status=dead}}</ref>

[[Strontium#Effect on the human body|Strontium]] is allied with calcium uptake into bones; at excessive dietary levels strontium has a rachitogenic (rickets-producing) action.<ref name="urlThe biological role of strontium">{{cite journal | vauthors = Pors Nielsen S | title = The biological role of strontium | journal = Bone | volume = 35 | issue = 3 | pages = 583–588 | date = September 2004 | pmid = 15336592 | doi = 10.1016/j.bone.2004.04.026 }}</ref>

===Sunlight===
Sunlight, especially ultraviolet light, lets human skin cells convert vitamin D from an inactive to active state. In the absence of vitamin D, dietary calcium is not properly absorbed, resulting in [[hypocalcaemia]], leading to skeletal and dental deformities and [[neuromuscular]] symptoms, e.g. hyperexcitability. Foods that contain vitamin D include butter, eggs, fish liver oils, margarine, fortified milk and juice, [[Agaricus bisporus|portabella]] and [[shiitake]] mushrooms, and [[oily fish]]es such as [[tuna]], [[herring]], and [[salmon]]. A rare [[X-linked dominant]] form exists called vitamin D-resistant rickets or X-linked hypophosphatemia.<ref>{{cite journal | vauthors = Wacker M, Holick MF | title = Sunlight and Vitamin D: A global perspective for health | journal = Dermato-Endocrinology | volume = 5 | issue = 1 | pages = 51–108 | date = January 2013 | pmid = 24494042 | pmc = 3897598 | doi = 10.4161/derm.24494 }}</ref>

Cases have been reported in Britain in recent years<ref>''[[Daily Telegraph]]'', page 4, Wednesday 19 January 2011</ref> of rickets in children of many social backgrounds caused by insufficient production in the body of vitamin D because the sun's ultraviolet light was not reaching the skin due to use of strong [[sunblock]], too much "covering up" in sunlight, or not getting out into the sun. Other cases have been reported among the children of some ethnic groups in which mothers avoid exposure to the sun for religious or cultural reasons, leading to a maternal shortage of vitamin D, and people with darker skin need more sunlight to maintain vitamin D levels.<ref>{{cite web | url = https://www.independent.co.uk/life-style/health-and-families/health-news/rise-in-rickets-linked-to-ethnic-groups-that-shun-the-sun-2319920.html | title = Rise in rickets linked to ethnic groups that shun the sun | work = [[The Independent]] | date = 25 July 2011 | access-date = 25 July 2011 }}</ref><ref>{{cite web | url = http://news.bbc.co.uk/1/hi/health/7161458.stm | title = Doctors fear rickets resurgence | work = [[BBC]] | date = 28 December 2007 | access-date = 25 July 2011 }}</ref>

Rickets had historically been a problem in [[London]], especially during the [[Industrial Revolution]]. Persistent thick fog and heavy industrial smog permeating the city blocked out significant amounts of sunlight to such an extent that up to 80 percent of children at one time had varying degrees of rickets in one form or the other.<ref>{{cite journal | vauthors = Holick MF | title = Resurrection of vitamin D deficiency and rickets | journal = The Journal of Clinical Investigation | volume = 116 | issue = 8 | pages = 2062–2072 | date = August 2006 | pmid = 16886050 | pmc = 1523417 | doi = 10.1172/JCI29449 }}</ref> It is sometimes known "the English Disease" in some foreign languages (e.g. German: {{Lang|de|Die englische Krankheit}}, Dutch: {{Lang|nl|Engelse ziekte}}, Hungarian: {{Lang|hu|angolkór}}, Swedish: {{Lang|sv|engelska sjukan}}).<ref>{{cite journal | vauthors = Bivins R | title = "The English disease" or "Asian rickets"? Medical responses to postcolonial immigration | journal = Bulletin of the History of Medicine | volume = 81 | issue = 3 | pages = 533–568 | date = 2007 | pmid = 17873451 | pmc = 2630160 | doi = 10.1353/bhm.2007.0062 }}</ref>

===Skin color theory===
Rickets is often a result of vitamin D3 deficiency. The correlation between human skin color and latitude is thought to be the result of positive selection to varying levels of solar ultraviolet radiation. Northern latitudes have selection for lighter skin that allows UV rays to produce vitamin D from 7-dehydrocholesterol. Conversely, latitudes near the equator have selection for darker skin that can block the majority of UV radiation to protect from toxic levels of vitamin D, as well as skin cancer.<ref>{{cite journal | vauthors = Loomis WF | title = Skin-pigment regulation of vitamin-D biosynthesis in man | journal = Science | volume = 157 | issue = 3788 | pages = 501–506 | date = August 1967 | pmid = 6028915 | doi = 10.1126/science.157.3788.501 | s2cid = 41681581 | bibcode = 1967Sci...157..501F }}</ref>

An anecdote often cited to support this hypothesis is that Arctic populations whose skin is relatively darker for their latitude, such as the Inuit, have a diet that is historically rich in vitamin D. Since these people acquire vitamin D through their diet, there is not a positive selective force to synthesize vitamin D from sunlight.<ref>{{cite journal | vauthors = Sharma S, Barr AB, Macdonald HM, Sheehy T, Novotny R, Corriveau A | title = Vitamin D deficiency and disease risk among aboriginal Arctic populations | journal = Nutrition Reviews | volume = 69 | issue = 8 | pages = 468–478 | date = August 2011 | pmid = 21790613 | doi = 10.1111/j.1753-4887.2011.00406.x | doi-access = free }}</ref>

Environment mismatch: vitamin D deficiency arises from a mismatch between an individual's previous and current environment. This risk of mismatch increases with advances in transportation methods and increases in urban population size at high latitudes.<ref>{{Cite journal |last1=Ames |first1=Bruce N. |last2=Grant |first2=William B. |last3=Willett |first3=Walter C. |date=2021-02-03 |title=Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? |journal=Nutrients |volume=13 |issue=2 |pages=499 |doi=10.3390/nu13020499 |doi-access=free |issn=2072-6643 |pmc=7913332 |pmid=33546262}}</ref>

Similar to the environmental mismatch when dark-skinned people live at high latitudes, Rickets can also occur in religious communities that require long garments with hoods and veils.<ref>{{cite journal | vauthors = Bachrach S, Fisher J, Parks JS | title = An outbreak of vitamin D deficiency rickets in a susceptible population | journal = Pediatrics | volume = 64 | issue = 6 | pages = 871–877 | date = December 1979 | pmid = 574626 | doi = 10.1542/peds.64.6.871 | s2cid = 26050085 }}</ref> These hoods and veils act as sunlight barriers that prevent individuals from synthesizing vitamin D naturally from the sun.<ref>{{cite web |title=RISE IN RICKETS LINKED TO ETHNIC GROUPS THAT SHUN THE SUN |website=[[Independent.co.uk]] |date=24 July 2011 |url=https://www.independent.co.uk/life-style/health-and-families/health-news/rise-in-rickets-linked-to-ethnic-groups-that-shun-the-sun-2319920.html |access-date=21 November 2021}}</ref>

In a study by Mithal et al.,<ref>{{cite journal |display-authors=6 |vauthors=Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J |date=November 2009 |title=Global vitamin D status and determinants of hypovitaminosis D |url=https://pubmed.ncbi.nlm.nih.gov/19543765/ |journal=Osteoporosis International |volume=20 |issue=11 |pages=1807–1820 |doi=10.1007/s00198-009-0954-6 |pmid=19543765 |s2cid=52858668}}</ref> vitamin D insufficiency of various countries was measured by lower 25-hydroxyvitamin D. 25(OH) D is an indicator of vitamin D insufficiency that can be easily measured. These percentages should be regarded as relative vitamin D levels, and not as predicting evidence for development of rickets.<ref>{{Cite journal |last=Cashman |first=Kevin D. |date=2022-01-11 |title=Global differences in vitamin D status and dietary intake: a review of the data |journal=Endocrine Connections |volume=11 |issue=1 |pages=e210282 |doi=10.1530/EC-21-0282 |issn=2049-3614 |pmc=8789021 |pmid=34860171}}</ref>

Asian immigrants living in Europe have an increased risk for vitamin D deficiency. Vitamin D insufficiency was found in 40% of non-Western immigrants in the Netherlands, and in more than 80% of Turkish and Moroccan immigrants.

The Middle East, despite high rates of sun-exposure, has the highest rates of rickets worldwide.<ref>{{cite web | url = http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Middle%20East_Africa/ME_audit-executive_summary.pdf | title = THE MIDDLE EAST & AFRICA REGIONAL AUDIT, Executive Summary, Epidemiology, costs & burden of osteoporosis in 2011 | archive-url = https://web.archive.org/web/20170825145111/https://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Middle%20East_Africa/ME_audit-executive_summary.pdf | archive-date=25 August 2017 }} The International Osteoporosis Foundation, www.iofbonehealth.org, retrieved 6 April 2017</ref> This fact can be explained by limited sun exposure due to cultural practices and lack of vitamin D supplementation for breast-feeding women. Up to 70% and 80% of adolescent girls in Iran and Saudi Arabia, respectively, have vitamin D insufficiency. Socioeconomic factors that limit a vitamin D rich diet also plays a role.
In the United States, vitamin D insufficiency varies dramatically by ethnicity. Among females aged 70 years and older, the prevalence of low serum 25(OH) D levels was 28.5% for non-Hispanic whites, 55% for Mexican Americans, and 68% for non-Hispanic blacks. Among males, the prevalence was 23%, 45%, and 58%, respectively.{{citation needed|date=September 2021}}

A systematic review published in the [[Cochrane Library]] looked at children up to three years old in Turkey and China and found a beneficial association between vitamin D and rickets. In Turkey, children getting vitamin D had only a 4% chance of developing rickets compared to children who received no medical intervention. In China, a combination of vitamin D, calcium and nutritional counseling was linked to a decreased risk of rickets.<ref>{{cite journal | vauthors = Lerch C, Meissner T | title = Interventions for the prevention of nutritional rickets in term born children | journal = The Cochrane Database of Systematic Reviews | volume = 2010 | issue = 4 | pages = CD006164 | date = October 2007 | pmid = 17943890 | pmc = 8990776 | doi = 10.1002/14651858.CD006164.pub2 }}</ref>

Parents can supplement their nutritional intake with vitamin D enhanced beverages if they feel their child is at risk for vitamin D deficiency.<ref>{{cite journal | vauthors = Weisberg P, Scanlon KS, Li R, Cogswell ME | title = Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003 | journal = The American Journal of Clinical Nutrition | volume = 80 | issue = 6 Suppl | pages = 1697S–1705S | date = December 2004 | pmid = 15585790 | doi = 10.1093/ajcn/80.6.1697S | doi-access = free }}</ref>

A 2019 review linked rickets disease to exclusive consumption of [[Neocate]] baby formula.<ref>{{cite journal | vauthors = Akhtar Ali S, Mathalikunnel A, Bhardwaj V, Braskett M, Pitukcheewanont P | title = Nutritional hypophosphatemic rickets secondary to Neocate® use | journal = Osteoporosis International | volume = 30 | issue = 9 | pages = 1887–1891 | date = September 2019 | pmid = 31143989 | doi = 10.1007/s00198-019-04836-8 | s2cid = 169034641 }}</ref>

==Diagnosis==
[[File:RicketsXray.jpg|thumb|upright=1.3|Wrist X-ray showing changes in rickets. Mainly cupping is seen here.]] [[File:RicketsChestXray.jpg|thumb|upright=1.3|Chest X-ray showing changes consistent with rickets. These changes are usually referred to as "rosary beads" of rickets.]]
Rickets may be diagnosed with the help of:
* Blood tests:<ref name="NHSChoice">{{cite web| url = http://www.nhs.uk/Conditions/Rickets/Pages/Diagnosis.aspx| title = NHS Choice - Rickets Diagnoses| date = 6 June 2018}}</ref>
** Serum [[calcium]] may show low levels of calcium, serum [[phosphorus]] may be low, and serum [[alkaline phosphatase]] may be high from bones or changes in the shape or structure of the bones. This can show enlarged limbs and joints.
* A [[bone density]] [[DXA|scan]] may be undertaken.<ref name="NHSChoice"/>
* [[Projectional radiography|Radiography]] typically show widening of the zones of provisional calcification of the [[metaphysis|metaphyses]] secondary to unmineralized osteoid. Cupping, fraying, and splaying of metaphyses typically appears with growth and continued weight bearing.<ref name="CheemaGrissom2003">{{cite journal | vauthors = Cheema JI, Grissom LE, Harcke HT | title = Radiographic characteristics of lower-extremity bowing in children | journal = Radiographics | volume = 23 | issue = 4 | pages = 871–880 | year = 2003 | pmid = 12853662 | doi = 10.1148/rg.234025149 | doi-access =  }}</ref> These changes are seen predominantly at sites of rapid growth, including the proximal humerus, distal radius, distal femur and both the proximal and the distal tibia. Therefore, a skeletal survey for rickets can be accomplished with anteroposterior radiographs of the knees, wrists, and ankles.<ref name="CheemaGrissom2003"/>

In [[Veterinary medicine|veterinary practice]], rickets, [[osteodystrophy]] and mineral metabolism disorders are diagnosed using an ultrasound echosteometer in the design [[Орлов, Матвей Михайлович|М.М. Orlov]] and [[Савинков, Алексей Владимирович|А.V. Savinkov]].<ref>{{Cite web|url=https://patents.google.com/patent/RU2779304C1/ru|title=Ветеринарный ультразвуковой эхоостеометр для оценки физических характеристик костей скелета животных при их функциональных и патологических изменениях | trans-title = Veterinary ultrasonic echo osteometer for the assessment of physical characteristics of the bones of the skeleton of animals with their functional and pathological changes | language = ru }}</ref><ref>{{Cite web|url=https://patenton.ru/patent/RU2779304C1|title=Ветеринарный ультразвуковой эхоостеометр для оценки физических характеристик костей скелета животных при их функциональных и патологических изменениях | trans-title = Veterinary ultrasonic echo osteometer for the assessment of physical characteristics of the bones of the skeleton of animals with their functional and pathological changes | language = ru }}</ref><ref>{{cite web | url = https://projects.2035.university/project/portativnyj-veterinarnyj-ultrazvukovoj-ehoosteometr-dla-ocenki-fiziceskih-harakteristik-kostej-skeleta-zivotnyh-pri-ih-funkcionalnyh-i-patologiceskih-izmeneniah | title = ПОРТАТИВНЫЙ ВЕТЕРИНАРНЫЙ УЛЬТРАЗВУКОВОЙ ЭХООСТЕОМЕТР ДЛЯ ОЦЕНКИ ФИЗИЧЕСКИХ ХАРАКТЕРИСТИК КОСТЕЙ СКЕЛЕТА ЖИВОТНЫХ ПРИ ИХ ФУНКЦИОНАЛЬНЫХ И ПАТОЛОГИЧЕСКИХ ИЗМЕНЕНИЯХ | trans-title = Portable Veterinary Ultravocation Echoosteometer For Assessment Of Physical Characteristics Of Animal Skeletal Bones With Functional And Pathological Changes | language = ru }}</ref>

===Types===
* Vitamin D-related rickets<ref name="AAFP">{{cite journal | vauthors = Nield LS, Mahajan P, Joshi A, Kamat D | title = Rickets: not a disease of the past | journal = American Family Physician | volume = 74 | issue = 4 | pages = 619–626 | date = August 2006 | pmid = 16939184 | url = http://www.aafp.org/afp/2006/0815/p619.html }}</ref>
** [[Vitamin D deficiency]]
** Vitamin D-dependent rickets (VDDR)<ref name=pmid32596195>{{cite journal | vauthors = Levine MA | title = Diagnosis and Management of Vitamin D Dependent Rickets | journal = Frontiers in Pediatrics | volume = 8 | pages = 315 | date = 2020 | pmid = 32596195 | pmc = 7303887 | doi = 10.3389/fped.2020.00315 | doi-access = free }}</ref>
*** Type 1: insufficiency in activation
**** VDDR1A: [[25-Hydroxyvitamin D3 1-alpha-hydroxylase]] deficiency
**** VDDR1B: [[CYP2R1]] deficiency
*** Type 2: resistance to calcitriol
**** VDDR2A: [[calcitriol receptor]] mutation
**** VDDR2B: unknown nuclear ribonucleoprotein interfering with signal transduction
*** Type 3: excessive inactivation ([[CYP3A4]] mutation, dominant)
* Hypocalcemia-related rickets
** [[Hypocalcemia]]
** [[Chronic kidney failure]] (CKD-BMD)
* Hypophosphatemia-related rickets
** Congenital
*** [[X-linked hypophosphatemia|Vitamin D-resistant rickets]]<ref name="AAFP"/>
*** [[Autosomal dominant hypophosphatemic rickets]] (ADHR)
*** Autosomal recessive hypophosphatemic rickets (ARHR)<ref name="PubMed">{{cite journal | vauthors = Levy-Litan V, Hershkovitz E, Avizov L, Leventhal N, Bercovich D, Chalifa-Caspi V, Manor E, Buriakovsky S, Hadad Y, Goding J, Parvari R | display-authors = 6 | title = Autosomal-recessive hypophosphatemic rickets is associated with an inactivation mutation in the ENPP1 gene | journal = American Journal of Human Genetics | volume = 86 | issue = 2 | pages = 273–278 | date = February 2010 | pmid = 20137772 | pmc = 2820183 | doi = 10.1016/j.ajhg.2010.01.010 }}</ref>
** [[Hypophosphatemia]] (typically secondary to malabsorption)
** [[Fanconi's syndrome]]
* Secondary to other diseases
** Tumor-induced osteomalacia
** [[McCune–Albright syndrome]]
** [[Epidermal nevus syndrome]]
** [[Dent's disease]]

===Differential diagnosis===
[[Osteochondrodysplasias]], also known as genetic bone diseases, may mimic the clinical picture of rickets in regard to the features of bone deformities.<ref name=elsobky2017>{{cite journal| vauthors = El-Sobky TA, Shawky RM, Sakr HM, Elsayed SM, Elsayed NS, Ragheb SG, Gamal R |title=A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children: A pictorial review.|journal= J Musculoskelet Surg Res|volume=1|issue=2|pages=25|date=15 November 2017|doi=10.4103/jmsr.jmsr_28_17|s2cid=79825711 |doi-access= free}}</ref> The radiologic picture and the laboratory findings of serum calcium, phosphate and alkaline phosphatase are important differentiating factors. [[Blount's disease]] is an important differential diagnosis because it causes knee deformities in a similar fashion to rickets namely bow legs or [[genu varum]]. Infants with rickets can have bone fractures. This sometimes leads to child abuse allegations. This issue appears to be more common for solely nursing infants of black mothers, in winter in temperate climates, suffering poor nutrition and no vitamin D supplementation.<ref name="pmid18810424">{{cite journal | vauthors = Keller KA, Barnes PD | title = Rickets vs. abuse: a national and international epidemic | journal = Pediatric Radiology | volume = 38 | issue = 11 | pages = 1210–1216 | date = November 2008 | pmid = 18810424 | doi = 10.1007/s00247-008-1001-z | s2cid = 5848331 }}</ref> People with darker skin produce less vitamin D than those with lighter skin, for the same amount of sunlight.<ref>{{cite web | vauthors = Walker C | date = 8 July 2011 | work = Live Strong | title=CDark Skin Color & Vitamin D | url=http://www.livestrong.com/article/311881-dark-skin-color-vitamin-d/| access-date = 2 June 2012}}</ref>

==Treatment==
===Diet and sunlight===
[[Image:Cholecalciferol.svg|thumb|100px|[[Cholecalciferol]] (D<sub>3</sub>)]]
[[Image:Ergocalciferol.svg|thumb|100px|[[Ergocalciferol]] (D<sub>2</sub>)]]
Treatment involves increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet B light (most easily obtained when the sun is highest in the sky), [[cod liver oil]], halibut-liver oil, and [[Ergosterol|viosterol]] are all sources of vitamin D.<ref>{{cite journal | vauthors = Lamberg-Allardt C | title = Vitamin D in foods and as supplements | journal = Progress in Biophysics and Molecular Biology | volume = 92 | issue = 1 | pages = 33–38 | date = September 2006 | pmid = 16618499 | doi = 10.1016/j.pbiomolbio.2006.02.017 | series = UV exposure guidance: A balanced approach between health risks and health benefits of UV and Vitamin D. Proceedings of an International Workshop, International Commission on Non-ionizing Radiation Protection, Munich, Germany, 17–18 October 2005 | doi-access = free }}</ref>

A sufficient amount of ultraviolet B light in sunlight each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned people need to be exposed longer to the [[ultraviolet|ultraviolet rays]]. The replacement of vitamin D has been proven to correct rickets using these methods of ultraviolet light therapy and medicine.<ref name="History"/>

Recommendations are for 400 [[international unit]]s (IU) of vitamin D a day for infants and children. Children who do not get adequate amounts of vitamin D are at increased risk of rickets. Vitamin D is essential for allowing the body to uptake calcium for use in proper bone calcification and maintenance.<ref>{{cite web |title=Rickets -- Symptoms and Causes |url=https://www.mayoclinic.org/diseases-conditions/rickets/symptoms-causes/syc-20351943 |website=Mayo Clinic Patient Care and Health Information |publisher=Mayo Clinic |access-date=27 January 2022}}</ref>

===Supplementation===
Sufficient vitamin D levels can also be achieved through dietary supplementation and/or exposure to sunlight. Vitamin D<sub>3</sub> ([[cholecalciferol]]) is the preferred form since it is more readily absorbed than vitamin D<sub>2</sub>. Most [[dermatology|dermatologists]] recommend vitamin D supplementation as an alternative to unprotected ultraviolet exposure due to the increased risk of [[skin cancer]] associated with sun exposure. Endogenous production with full body exposure to sunlight is approximately 250&nbsp;μg (10,000 IU) per day.<ref name="Vieth">{{cite journal | vauthors = Vieth R | title = Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety | journal = The American Journal of Clinical Nutrition | volume = 69 | issue = 5 | pages = 842–856 | date = May 1999 | pmid = 10232622 | doi = 10.1093/ajcn/69.5.842 | doi-access = free }}</ref>

According to the [[American Academy of Pediatrics]] (AAP), all infants, including those who are exclusively breast-fed, may need vitamin D supplementation until they start drinking at least {{convert|17|USfloz|ml}} of vitamin D-fortified milk or formula a day.<ref>{{cite journal | vauthors = Gartner LM, Greer FR | title = Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake | journal = Pediatrics | volume = 111 | issue = 4 Pt 1 | pages = 908–910 | date = April 2003 | pmid = 12671133 | doi = 10.1542/peds.111.4.908 | doi-access = free }}</ref>

Despite this recommendation, a recent [[Cochrane (organisation)|Cochrane]] [[systematic review]] has found limited evidence that vitamin D plus calcium, or [[Calcium in biology|calcium]] alone compared to vitamin D improves healing in children with nutritional rickets.<ref>{{cite journal | vauthors = Chibuzor MT, Graham-Kalio D, Osaji JO, Meremikwu MM | title = Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 4 | pages = CD012581 | date = April 2020 | pmid = 32303107 | pmc = 7164979 | doi = 10.1002/14651858.CD012581.pub2 | collaboration = Cochrane Metabolic and Endocrine Disorders Group }}</ref>

===Surgery===
Occasionally surgery is needed to correct severe and persistent deformities of the lower limbs, especially around the knees namely [[genu varum]] and [[genu valgum]]. Surgical correction of rachitic deformities can be achieved through osteotomies or guided growth surgery. Guided growth surgery has almost replaced the use of corrective osteotomies. The functional results of guided growth surgery in children with rickets are satisfactory. While bone osteotomies work through acute/immediate correction of the limb deformity, guided growth works through gradual correction.<ref name= JAAOSGlobal/>

==Epidemiology==
In developed countries, rickets is a [[rare disease]]<ref>{{cite web | url = http://www.nhs.uk/conditions/Rickets/Pages/Introduction.aspx | work = National Health Service of England | title = Rickets | date = 28 January 2010 }}</ref> (incidence of less than 1 in 200,000).  Recently, cases of rickets have been reported among children who are not fed enough vitamin D.<ref name = "Koehler_2016" />

In 2013/2014 there were fewer than 700 cases in England.<ref name = "Koehler_2016">{{cite web | vauthors = Koehler G | date = 20 October 2014 |title=Rickets and osteomalacia|url=https://www.nhs.uk/conditions/rickets-and-osteomalacia/ | archive-url = https://web.archive.org/web/20160423105458/http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2014/20141020_hn | archive-date = 23 April 2016 |website=nhs.uk|access-date=24 December 2017}}</ref> In 2019 the number of cases hospitalised was said to be the highest in 50 years.<ref>{{cite news | vauthors = Baraniuk C |title=How going hungry affects children for their whole lives |url=https://www.independent.co.uk/news/long_reads/hunger-food-insecurity-mental-health-physical-food-bank-children-a8859671.html |access-date=4 June 2019 |newspaper=Independent |date=17 May 2019}}</ref>

Rickets occurs relatively commonly in the [[Middle East]], Africa, and Asia.<ref name=Cre2017/>

== History ==
[[File:Skeleton Infant Rickets.jpeg|thumb|upright=0.6|''Skeleton of Infant with Rickets'', 1881]]

Greek physician [[Soranus of Ephesus]], one of the chief representatives of the [[Methodic school]] of medicine who practiced in [[Alexandria]] and subsequently in [[Rome]], reported deformation of the bones in infants as early as the first and second centuries AD. The first use of the word 'rickets' is the handwritten entry for 25 February 1632 in 'Receipt Books' of the [[Lord Fairfax of Cameron|Fairfax Family]] which lists five remedies for 'rickets in children'. The word 'rickets' first occurred in print in 1634 in the Annual Bill of Mortality of the City of London.<ref name=":1" /> Rickets was not defined as a specific medical condition until 1645, when an English physician [[Daniel Whistler]] gave the earliest known description of the disease. 

In 1650, a treatise on rickets was published by [[Francis Glisson]], a physician at [[Caius College, Cambridge]],<ref>{{cite web |url=http://www.livinghealthy360.com/index.php/the-history-of-rickets-scurvy-and-other-nutritional-deficiencies-42959/|title= The History of Rickets, Scurvy and Other Nutritional Deficiencies | vauthors = Claerr J |date= 6 February 2008|work= An Interesting Treatise on Human Stupidity|publisher= [[Yahoo! Voices]] |archive-url= https://web.archive.org/web/20140702101552/http://www.livinghealthy360.com/index.php/the-history-of-rickets-scurvy-and-other-nutritional-deficiencies-42959/|archive-date= 2014-07-02|url-status=usurped|quote= URL references }}</ref> who said it had first appeared about 30 years previously in the counties of [[Dorset]] and [[Somerset]].<ref>{{cite journal | vauthors = Gibbs D | title = Rickets and the crippled child: an historical perspective | journal = Journal of the Royal Society of Medicine | volume = 87 | issue = 12 | pages = 729–732 | date = December 1994 | pmid = 7503834 | pmc = 1294978 }}</ref> 

In 1857, [[John Snow (physician)|John Snow]] suggested rickets, then widespread in Britain, was being caused by the adulteration of bakers' bread with [[alum]].<ref>{{cite journal | vauthors = Dunnigan M | title = Commentary: John Snow and alum-induced rickets from adulterated London bread: an overlooked contribution to metabolic bone disease | journal = International Journal of Epidemiology | volume = 32 | issue = 3 | pages = 340–341 | date = June 2003 | pmid = 12777415 | doi = 10.1093/ije/dyg160 | doi-access = free }}</ref> 

German pediatrician [[Kurt Huldschinsky]] successfully demonstrated in the winter of 1918–1919 how rickets could be treated with [[ultraviolet]] lamps. 

Between 1918 and 1920, the role of diet in the development of rickets was determined by [[Edward Mellanby]].<ref>{{cite journal | vauthors = Pileggi VJ, De Luca HF, Steenbock H | title = The role of vitamin D and intestinal phytase in the prevention of rickets in rats on cereal diets | journal = Archives of Biochemistry and Biophysics | volume = 58 | issue = 1 | pages = 194–204 | date = September 1955 | pmid = 13259690 | doi = 10.1016/0003-9861(55)90106-5 }}</ref><ref>{{cite journal | vauthors = Ford JA, Colhoun EM, McIntosh WB, Dunnigan MG | title = Biochemical response of late rickets and osteomalacia to a chupatty-free diet | journal = British Medical Journal | volume = 3 | issue = 5824 | pages = 446–447 | date = August 1972 | pmid = 5069221 | pmc = 1786011 | doi = 10.1136/bmj.3.5824.446 }}</ref><ref name="History"/> 

In 1923, American physician [[Harry Steenbock]] demonstrated that irradiation by ultraviolet light increased the vitamin D content of foods and other organic materials. Steenbock's irradiation technique was used for foodstuffs, but most memorably for milk. 

By 1945, rickets had all but been eliminated in the United States.<ref>{{Cite journal |last1=Bouillon |first1=Roger |last2=Antonio |first2=Leen |date=2020 |title=Nutritional rickets: Historic overview and plan for worldwide eradication |url=https://doi.org/10.1016/j.jsbmb.2019.105563 |journal=The Journal of Steroid Biochemistry and Molecular Biology |volume=198 |pages=105563 |doi=10.1016/j.jsbmb.2019.105563 |pmid=31809867 |issn=0960-0760}}</ref> 

However, beginning around 2003, rickets reemerged as an issue in the US for some populations<ref>{{Cite journal |last1=Rajakumar |first1=Kumaravel |last2=Thomas |first2=Stephen B. |date=2005-04-01 |title=Reemerging Nutritional Rickets: A Historical Perspective |url=http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpedi.159.4.335 |journal=Archives of Pediatrics & Adolescent Medicine |language=en |volume=159 |issue=4 |pages=335–341 |doi=10.1001/archpedi.159.4.335 |pmid=15809385 |issn=1072-4710}}</ref> causing the [[American Academy of Pediatrics]] recommended that all infants have Vitamin D intake of 200 IU per day.<ref name=aap01>{{cite journal | pmc=3612965 | date=2013 | last1=Thacher | first1=T. D. | last2=Fischer | first2=P. R. | last3=Tebben | first3=P. J. | last4=Singh | first4=R. J. | last5=Cha | first5=S. S. | last6=Maxson | first6=J. A. | last7=Yawn | first7=B. P. | title=Increasing Incidence of Nutritional Rickets: A Population-Based Study in Olmsted County, Minnesota | journal=Mayo Clinic Proceedings. Mayo Clinic | volume=88 | issue=2 | pages=176–183 | doi=10.1016/j.mayocp.2012.10.018 | pmid=23374621 }}</ref>

===Etymology===
The word ''rickets'' may be from the [[Old English]] word {{Lang|ang|wrickken}} ('to twist'), although because this is conjectured, several major dictionaries simply say "origin unknown". The name ''rickets'' is [[English plurals#Plural in form but singular in construction|plural in form but usually singular in construction]]. The Greek word {{Lang|grc-latn|rachitis}} ({{Lang|grc|ῥαχίτης}},<ref name=":0"/> meaning 'in or of the spine') was later adopted as the scientific term for rickets, due chiefly to the words' similarity in sound.
<!-- Removed very confusing passage: "Vide: Aubrey's Brief Lives: the word has no connection whatever with the Greek rachitis. I quote:

" about 1620 one Ricketts of Neerye a Practictioner of Physick was excellent at the Curing Children with swoln heads, and small legges: and the Disease being new, and without a name, He being so famous for the cure of it, they called the Disease the Ricketts: as the King's Evill from the King's cureing of it with his Touch; and now 'tis good sport to see how they vex their Lexicons, and fetch it from the Greek PaXis, the back bone."" -->

== See also ==
* [[Hypervitaminosis D]]
{{Clear}}

== References ==
{{Reflist}}

== External links ==
* {{Commons category-inline|Rickets}}

{{Medical resources
| ICD11           = {{ICD11|5B57.0}}
| ICD10           = {{ICD10|E55.0}}
| ICD9            = {{ICD9|268}}
| DiseasesDB      = 9351
| eMedicineSubj   = ped
| eMedicineTopic  = 2014
| MedlinePlus     = 000344
| meshName        = Rickets
| meshNumber      = D012279}}
{{Nutritional pathology}}
{{Authority control}}

[[Category:Skeletal disorders]]
[[Category:Vitamin D]]
[[Category:Vitamin deficiencies]]
[[Category:Wikipedia medicine articles ready to translate]]