This two important problems that may arise if

This lesson will discuss two similar conditions that are called osteomalacia and rickets. You’ll find out whom they affect, why it happens, how they are diagnosed, and how they may be treated.

Vitamin D Fortified Food

The next time you walk down the aisle of a grocery store, stop and look to see how many foods are advertised as being fortified with vitamin D. There’s tons of them. They range from cheese to even orange juice! The reason we fortify our food with vitamin D is because it’s super important to our health, as you’ll find out when we discuss two important problems that may arise if you don’t get enough of it.

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What are Osteomalacia and Rickets?

These two problems are related in their association to vitamin D and are broken down by age. In adults, the condition is called osteomalacia; and in children, it’s known as rickets. Each one is a condition where prolonged and excessive vitamin D deficiency causes bones to soften, weaken, and easily fracture.While many conditions, such as kidney disease, can influence the amount of vitamin D present in the body, another risk factor for developing this condition is not getting enough sun exposure.

I know that sounds really weird, but I wouldn’t be surprised if you already knew that the sun and vitamin D are linked!

Why Do Osteomalacia and Rickets Occur?

What happens is that the sun’s light rays, namely the ones called UVB rays, hit your skin and cause a form of cholesterol located in your skin to convert to a precursor form of vitamin D that is known as cholecalciferol, or vitamin D3. Cholecalciferol (vitamin D3) is also the form of vitamin D that is found in many supplements and vitamin D fortified foods you buy.This form of vitamin D then travels to the liver, where it is converted to an intermediary called calcidiol, and from there the calcidiol travels to the kidneys where it is finally made into the biologically active form of vitamin D that is known as calcitriol. Calcitriol can then signal your intestines to increase the absorption of calcium and phosphate from your diet, which are important in keeping your bones healthy and strong.This entire process can be thought of as a Rube Goldberg machine where the input, in our case cholecalciferol, triggers a chain of events throughout the entire body that results in a completely different output once all of the gears have turned and dominoes have fallen, so to speak.Now, let’s reverse all this.

Let’s say someone is deficient in vitamin D either because they don’t get enough through their diet or through exposure to sunlight. These individuals won’t be able to absorb nearly as much calcium and phosphorus from their diet.So, whether it’s lack of sunlight, lack of a proper diet, kidney disease that affects it ability to make calcitriol, or something else, the end result is a lack of vitamin D. That lack of vitamin D, over time, may lead to osteomalacia in adults or rickets in children.

Clinical Signs, Symptoms, and Diagnostics

Children with rickets will suffer from stunted growth, bowing of the legs, and thick wrist or ankles.

Adults with osteomalacia will have pain in their lower spine, pelvis, hips, and legs.A doctor will not only look for these signs and perform some X-rays to take a closer look at a person’s bones, but may also run some blood tests to help figure out the exact cause of the problem. For example, in adults, the signs of osteomalacia may mimic arthritis, osteoporosis, osteopetrosis, and many other problems. However, in all of those conditions except for osteomalacia, the levels of calcium and phosphate in the blood will be normal. In osteomalacia, they will be decreased.

While measuring calcium and phosphate levels can indirectly tell us that there’s a problem, these levels can be influenced by many other diseases not associated directly with vitamin D issues. Therefore, we can also measure the levels of calcidiol, the liver intermediary I mentioned before, in order to gauge how much vitamin D a person has in their body a bit more directly.As you can clearly tell, medicine is quite tricky, as many factors can be influenced for many different reasons.

That’s why the more direct a test we can use, the better.

Treatment and Prevention of Osteomalacia and Rickets

The treatment of this condition is relatively straightforward. We supplement people with vitamin D and, if necessary, calcium and phosphorus as well. But, we don’t want to give too much, either, as giving too much of anything, including vitamin D, can be a bad thing. In children who have serious deformities as a result of rickets, braces or even surgery may be required.

Furthermore, any person who suffers from a disease that affects vitamin D metabolism, such as one that affects the kidneys, may need those underlying issues addressed with other medications and treatments.

Lesson Summary

In this lesson, we covered two conditions. In adults, the condition is called osteomalacia; and in children, it’s known as rickets. Each one is a condition where prolonged and excessive vitamin D deficiency causes bones to soften, weaken, and easily fracture.

Remember that calcitriol is the biologically active form of vitamin D and is what we’re concerned about in these two cases. If you don’t have enough vitamin D, your bones begin to break apart, and this will cause children to experience stunted growth and adults to experience pain.To diagnose these two problems, a doctor will measure the levels of calcidiol in order to gauge how much vitamin D a person has in their body a bit more directly. Once diagnosed, the treatment of this condition is relatively straightforward. We supplement people with vitamin D and, if necessary, calcium and phosphorus as well.

Learning Outcomes

You’ll have the ability to do the following after this lesson:

  • Describe what causes osteomalacia and rickets
  • Identify the forms of vitamin D in the body, from the precursor to the biologically active form
  • Explain how vitamin D deficiency diseases are diagnosed and treated
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