Rickets (synonyms: English disease; juvenile osteomalacia; ICD-10 E55.0, E64.3) refers to a disorder of bone metabolism in children during the growth phase that results in marked demineralization of bone (“bone softening”) and skeletal changes due to retardation of bone growth. In adults with completed bone growth, the symptomatology is called osteomalacia (ICD-10 M83: Osteomalacia in Adulthood). Osteomalacia, like rickets, is a systemic bone disease. It is associated with decreased mineralization of bone.
The cause of osteomalacia is either a deficiency of active vitamin D (vitamin D-dependent osteomalacia/calcipenic form of osteomalacia) or a disorder in phosphate metabolism (phosphopenic/hypophosphatemic form of osteomalacia).
One can distinguish calcipenic from phosphopenic forms of rickets:
Calcipenic rickets (E83.31) include:
- Vitamin D deficiency
- Vitamin D-dependent rickets type I
- Vitamin D-dependent rickets type II
- Calcium deficiency
Phosphopenic rickets include:
- Osteopathy of prematurity
- Familial hypophosphatemic rickets (ICD-10 E83.30).
- Tumor-induced hypophosphatemic rickets (E83.38).
- Fanconi syndrome – inherited dysfunction of the energy balance of the proximal tubule cells of the kidney.
Sex ratio: balanced.
Frequency peak: rickets affects only children, usually between the second month of life to the second year of life.
Rickets is not a notifiable disease, so there are few figures on incidence. African-American children are the most commonly affected worldwide. In Europe, rickets has been observed more frequently in infants and young children fed a macrobiotic* diet. No figures are available for osteomalacia with regard to prevalence (frequency of disease) and incidence (frequency of new cases) in Germany.
Course and prognosis: Under adequate drug therapy (high-dose vitamin D substitution as well as calcium substitution), the prognosis is good. Normally, the skeletal changes are reversible (reversible).
* In the original macrobiotics according to Ohsawa, mainly whole grain rice, some cooked vegetables, legumes, seaweed and plenty of table salt are consumed. Only a minimum of liquid should be drunk. Raw vegetables, fruits, herbs, meat, dairy products, sugar and stimulants should be avoided.
Comorbidity (concomitant disease): osteoporosis (bone loss), this often develops in coincidence due to malabsorption.
