AI Summary Overview
How is Rickets Diagnosed?
Children suspected of having rickets need to be examined by a paediatrician, a paediatric endocrinologist, or an orthopaedist. The diagnosis is done via physical exams and lab tests to check serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphate, alkaline phosphatase, and parathyroid hormone (PTH). Further, X-ray imaging can be used to examine the wrist, knee, or other long bones for characteristic deformities.
If inherited or treatment-resistant rickets is suspected, further investigations, such as genetic testing or specialised biochemical tests, may be required.
How is Rickets Treated Based on Its Severity?
The treatment of rickets will depend on the severity of vitamin D deficiency, the presence of bone deformities, and the underlying cause of the disorder. The treatment approaches, as per the severity of the condition, are listed below:
| Severity | Treatment Approach |
| Mild | Nutritional rickets of mild severity can be managed through supplementation of oral vitamin D, calcium, if needed, diet, and sunlight. |
| Moderate | In moderate cases of nutritional rickets, the management involves administration of vitamin D in higher doses for some weeks or months, with supplementation of calcium as well. |
| Severe | In severe cases where there are bone deformities, fractures, hypocalcaemia, and problems in growth, hospitalisation with specialist management may be required. |
Types of Rickets and Their Treatment
There are different methods of treating rickets, depending on the nature and cause of the condition, as mentioned below:
| Types of Rickets | Treatment |
| Nutritional Rickets | Treated with vitamin D and calcium supplements where necessary, diet modification, and sunlight exposure. |
| Vitamin D-Dependent Rickets Type 1 | Treated using active forms of vitamin D, including calcitriol and calcium supplementation. |
| Vitamin D-Dependent Rickets Type 2 | Calcitriol and calcium in high concentrations might be necessary, along with the involvement of a paediatric endocrinologist. |
| Hypophosphataemic Rickets | Treated using phosphate supplements and active vitamin D, such as calcitriol. Some cases can benefit from burosumab. |
| Renal Rickets (Renal Osteodystrophy) | Management includes treatment of chronic kidney disease, correction of calcium/phosphate imbalance, and the use of active vitamin D preparations where appropriate. |
Topical Treatment for Rickets
Topical treatments have no place in the management of rickets, since the disease needs correction of vitamin D, calcium, or phosphorus deficiencies.
Other Treatments for Rickets
The following are some of the other treatment approaches for rickets:
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Vitamin D Injections Intramuscular vitamin D injections are given to children with severe deficiencies, poor compliance, or malabsorption conditions.
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Braces Orthopaedic braces may help support selected children with developing deformities while the underlying deficiency is corrected by medical treatment.
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Orthopaedic Surgery Children with severe bone deformities may require corrective surgeries like osteotomy after correcting their metabolic abnormalities.
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Burosumab Treatment This drug is a monoclonal antibody that may be prescribed for eligible patients with X-linked hypophosphataemic rickets under specialist supervision.
Oral Medications for Rickets Treatment
The following oral medications have been used in the treatment of rickets:
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Cholecalciferol (Vitamin D3)
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Ergocalciferol (Vitamin D2)
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Calcium carbonate
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Calcium citrate
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Calcitriol
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Phosphate
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Alfacalcidol
Note: These medications should be used only under medical supervision, as treatment varies according to the type and cause of rickets.
Ayurvedic and Alternative Treatments for Rickets
The following alternative therapies might be used for the treatment of rickets:
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Surya snana (exposure to sunlight) can help in the natural synthesis of vitamin D.
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Ayurvedic dietary modifications according to Ayurveda can include calcium and vitamin D-rich foods.
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Physiotherapy exercises may help strengthen muscles and improve mobility during recovery.
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Oil massage (abhyanga) might be helpful as a supportive therapy for sore muscles.
Note: Do not use these treatments as a substitute for prescribed vitamin D and calcium supplements.
Home Care for Managing Rickets
Home care measures that may prove helpful for children being treated for rickets include the following:
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Regular intake of prescribed vitamin D and calcium supplements.
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Safe and adequate exposure to sunlight.
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Inclusion of calcium and vitamin D-rich foods in the diet.
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Regular checkups and blood tests.
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Age-appropriate physical activities, as per medical advice, to strengthen bones.
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Orthopaedic instructions in case of prescribed braces or other corrective devices.
How Long Does Rickets Treatment Take?
The duration of treatment is determined by the cause of rickets, its severity, and the patient’s response to therapy. The duration of different types of rickets treatment is:
| Treatment | Duration |
| High-dose Vitamin D therapy | Usually prescribed for 6–12 weeks as a treatment for deficiency. |
| Maintenance Vitamin D supplementation | Continued for several months or more, depending on age, dietary intake, underlying cause, and risk of recurrence. |
| Calcium supplementation | It can be used for 2–6 months in cases of low calcium levels and for healing bones. |
| Intramuscular Vitamin D injection | It can be administered once or repeated every 8–12 weeks if necessary. |
| Phosphate Supplementation | It often needs to be used long-term, especially in hypophosphataemic rickets. |
| Calcitriol therapy | It is often used long-term or lifelong in inherited or renal rickets. |
| Orthopaedic bracing | Frequent use is needed for months to years, depending on bone growth and correcting deformities. |
| Corrective orthopaedic surgery | It usually takes 6-12 weeks, but bone remodelling can take longer. |
Rickets Treatment Side Effects
Rickets treatment is usually well-tolerated. However, the following side effects may occur depending on the treatment method used:
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Nausea
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Vomiting
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Abdominal pain
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Increased thirst
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Increased frequency of urination
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Hypercalcaemia
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Kidney stones from chronic high vitamin D or calcium intake
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Diarrhoea from phosphate intake
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Local reaction at the injection site with burosumab
Lifestyle Changes for Managing Rickets
Some lifestyle changes for managing rickets include:
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Get sufficient sunlight to increase Vitamin D levels.
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Include foods rich in calcium and vitamin D in your diet.
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Practice age-appropriate physical exercises.
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Go for regular health checkups and blood tests.
Triggers That Can Worsen Symptoms of Rickets
Factors that can complicate rickets or hinder recovery include the following:
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Insufficient exposure to sunlight.
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Low consumption of calcium foods.
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Low compliance with vitamin D supplements.
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Absorption difficulties like coeliac disease.
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Liver or kidney diseases.
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Anticonvulsant and corticosteroid medications.
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Delayed diagnosis or treatment interruption.
Rickets Treatment Cost in India
Treatment costs for rickets in India depend on the cause and severity of the condition. Treatment for mild nutritional rickets with vitamin D supplements, calcium supplements, and consultation charges may cost about ₹500-₹3,000 per month.
However, treatment for severe rickets, which involves repeated medical investigations, consultation by specialists, orthopaedic treatment, and surgery, may cost about ₹20,000-₹2 lakh or more. Moreover, investigations, including vitamin D levels, calcium, phosphate, and X-ray investigations, may cost around ₹1,500-₹6,000.
Does Health Insurance Cover Rickets Treatment in India
Yes. Treatment of rickets is covered under health insurance in India, as per the policy terms, severity of the condition and the treatment required. Policies may cover the cost of hospitalisation, corrective surgery and treatment of complications. Outpatient consultation, nutritional supplements, and routine follow-up visits may be covered under the policy only if it comes with OPD cover.
Therefore, people should review their policy documents or check coverage with their insurer before filing a claim.
Frequently Asked Questions (FAQs)
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Q1. Can rickets be cured permanently?
Ans: Nutritional rickets can usually be cured with timely treatment using vitamin D, calcium, and dietary modifications. -
Q2. What is the best treatment for rickets?
Ans: Vitamin D supplementation combined with adequate calcium intake is the most effective treatment for nutritional rickets. -
Q3. How long does rickets treatment take?
Ans: Most children with rickets show improvement within a few weeks, but treatment and follow-up may continue for several months.
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References
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https://www.healthline.com/health/rickets
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https://pmc.ncbi.nlm.nih.gov/articles/PMC9395459/
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https://www.1mg.com/labs/test/vitamin-d-25-hydroxy-1972
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https://www.apollo247.com/lab-tests/25-hydroxy-vitamin-d-d2d3
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