Published: 18 Jun 2025

ICD9: 268.0      ICD10: E55.0      ICD11: 5C63.22

Rickets and osteomalacia are conditions caused by a deficiency in vitamin D, calcium, or phosphate, leading to weakened and softened bones.
While they share the same underlying cause, they affect different age groups and have slightly different manifestations.

Here's a breakdown:

Rickets: This primarily affects children, specifically those with growing bones. Vitamin D deficiency during bone growth prevents proper calcification of the growth plates (the areas at the ends of long bones where growth occurs). This leads to skeletal deformities.

Osteomalacia: This affects adults, whose bones have already stopped growing. In osteomalacia, the existing bone matrix doesn't mineralize properly, leading to softening of the bones and increased risk of fractures.

Key Differences Summarized:

| Feature | Rickets (Children) | Osteomalacia (Adults) |
|----------------|-----------------------------|-----------------------------|
| Age Group | Infants and Children | Adults |
| Bone Growth | Affects growth plates | Affects existing bone matrix |
| Manifestation | Skeletal deformities | Bone pain, muscle weakness, fractures |

Causes:

Vitamin D Deficiency:
Inadequate Sunlight Exposure: Vitamin D is primarily produced in the skin upon exposure to sunlight. Lack of outdoor time, especially in regions with limited sunlight, can lead to deficiency.
Dietary Deficiency: Insufficient intake of vitamin D-rich foods (e.g., fatty fish, egg yolks, fortified milk) can contribute.
Malabsorption: Conditions like celiac disease, Crohn's disease, or gastric bypass surgery can interfere with vitamin D absorption.

Calcium Deficiency:
Dietary Deficiency: Insufficient calcium intake, particularly in children and adolescents, can contribute.

Phosphate Deficiency:
This is less common but can occur due to certain genetic disorders or kidney problems.

Kidney or Liver Disease: These organs play a crucial role in activating vitamin D. Impaired function can lead to deficiency.

Certain Medications: Some medications can interfere with vitamin D metabolism.

Symptoms:

Rickets (Children):

Skeletal Deformities: Bowed legs, knock knees, spinal curvature (scoliosis), enlarged wrists and ankles.
Delayed Growth: Slowed growth and development.
Dental Problems: Delayed tooth eruption, dental defects.
Bone Pain: Aching or tenderness in bones.
Muscle Weakness: Can affect motor skills.
Craniotabes: Softening of the skull bones in infants.

Osteomalacia (Adults):

Bone Pain: Diffuse, aching bone pain, often in the hips, lower back, and legs.
Muscle Weakness: Especially in the proximal muscles (muscles closer to the trunk).
Difficulty Walking: Waddling gait due to muscle weakness and bone pain.
Increased Risk of Fractures: Bones become brittle and prone to fractures, even with minor trauma.
Muscle Cramps: Low calcium levels can contribute to muscle cramps.
Fatigue: General feeling of tiredness and weakness.

Diagnosis:

Physical Exam: Assessing for bone deformities and tenderness.
Blood Tests: Measuring vitamin D, calcium, phosphate, and alkaline phosphatase (an enzyme elevated in bone turnover).
X-rays: Showing characteristic bone changes, such as bowing of legs in rickets or Looser's zones (pseudofractures) in osteomalacia.
Bone Density Scan (DEXA): To assess bone mineral density.
Bone Biopsy: Rarely needed, but can confirm the diagnosis.

Treatment:

The primary goal of treatment is to correct the underlying vitamin D, calcium, or phosphate deficiency.

Vitamin D Supplementation: High doses of vitamin D are usually prescribed.
Calcium Supplementation: If calcium levels are also low.
Phosphate Supplementation: If phosphate levels are low (less common).
Sunlight Exposure: Increased time spent outdoors, when possible.
Dietary Modifications: Consuming foods rich in vitamin D and calcium.
Orthopedic Management: Braces or surgery may be needed to correct severe skeletal deformities.
Treating Underlying Conditions: Addressing any medical conditions that may be contributing to the deficiency (e.g., malabsorption disorders, kidney disease).

Prevention:

Adequate Sunlight Exposure: Encourage regular outdoor activity, especially for children and pregnant women.
Vitamin D-Rich Diet: Consume foods like fatty fish, egg yolks, and fortified milk.
Vitamin D Supplementation: Consider supplementation, especially for infants, pregnant and breastfeeding women, older adults, and individuals with limited sunlight exposure.
Calcium Intake: Ensure adequate calcium intake through diet or supplements, especially during childhood and adolescence.

In summary, rickets and osteomalacia are conditions resulting from inadequate bone mineralization due to deficiencies in vitamin D, calcium, or phosphate. Rickets affects growing children, leading to skeletal deformities, while osteomalacia affects adults, causing bone pain, muscle weakness, and increased fracture risk. Treatment focuses on correcting the underlying deficiency and managing complications.

Important Note: This information is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment. Self-treating can be dangerous.