Rickets By: Janice Jones

What is Rickets? Rickets- a disorder caused by lack of vitamin D, calcium, or phosphate, leading to softening and weakening of the bones. Vitamin D helps the body control calcium and phosphate levels. When Vitamin D becomes too low in blood levels, the body produces hormones that cause calcium and phosphate to leave the bones.

Pathology Symptoms include: bone pain and tenderness in arms, legs, pelvis, and spine. More severe symptoms include: dental deformities, and skeletal deformities.

History of Rickets There were reports as early as the second century of rickets. During the 17th century there was an outbreak of Rickets, as recorded by Cambridge Professor Francis Glisson. It became known as the “English disease”. It then became rampant during the Industrial Revolution in United States, Europe, and the UK. It was particularly rampant among immigrants, and poverty stricken communities. It was not until 1920, Elmer McCullem, discovered it was a vitamin deficiency.

Rickets commonly occurs in children from infancy to 18 months. Epidemiology Lack of Vitamin D occurs in people who live in climates with little exposure to sunlight. Or not enough through diet due to lactose intolerance. Rickets commonly occurs in children from infancy to 18 months. Is common among children who are black or breastfed.

Epidemiology There is a form of hereditary Rickets, the kidneys are not able to hold on to the phosphate Renal Tubular acidosis- Kidney disorder unable to uptake phospate as well

Treatment Dietary Rickets can be treated through increase uptake of Vitamin D by moderate exposure to sunlight (light therapy), increase in whole milk, whole grains, cod liver oil, and most fortified dairy products. Surgery may be used to correct some bone deformities. It is important that disease is detected before effects are irreversible. RDI for Vitamin D is between 400-800 IU

Breakfast Meal Plan Day 1 Vitamin D (IU) Day 2 Vitamin D Day 3 Glass of 2% milk with Vit A & D 104.8 Instant breakfast w/whole milk 100.0 1% milk 126.8 Yogurt, banana creme 80.0 blueberries Wheaties 39.9 1 serving of Kix cereal 42.3 Glass of 2% with A&D Total: 227.1 204.8 166.7

Lunch Menu Day 1 Vitamin D Day 2 Day 3 Energy bar 80 Ham sandwhich, whole wheat 27.5 Omelette with sausage 53.4 Tuna salad sandwich 72 Vanilla milk shake 60.6 1% milk 126.8 Glass of 2% milk 104.8 Total: 256.8 88.1 180.2

Dinner Menu Day 1 Vitamin D Day 2 Day 3 Thai sweet noodles 50.8 Shrimp cocktail 147.2 2% milk 104.8 Vegetables, mixed 54.7 Sourdough bread 35.2 Tuna Fish 154.6 1% Milk 126.8 Vegetables mixed Daily total: 694.2 602.1 661

What Vitamin is deficient for someone with Rickets? Questions What Vitamin is deficient for someone with Rickets? Vitamin D What is the RDI for Vitamin D? 400-800 IU Vitamin D can come from what sources? Sun, Cod liver oil, whole wheats, fortified dairy products.

Sources http://bestpractice.bmj.com/be st- practice/monograph/635/basics /epidemiology.html http://ods.od.nih.gov/factsheet s/VitaminD-HealthProfessional/ http://www.ncbi.nlm.nih.gov/p ubmedhealth/PMH0001384/ Food Composition Table, 2009. Mcgraw & Hill Scholarly Article- History of Rickets in US. Sister Mary Theodora Weick. The America Journal of Clinical Nutrition. 1967. http://www.ajcn.org/content/2 0/11/1234.full.pdf