There is no single definition, since there are several types of rickets. The most common is deficiency rickets due to lack of vitamin D. With the help of pediatrician Jorge García-Dihinx, we clarify all doubts.
What is rickets?
It is a bone metabolism disease that affects children in which bone mineralization decreases and growth cartilage is altered. The most common type of rickets is deficiency, “but there is hypophosphatemic rickets or rickets secondary to kidney diseases due to malabsorption,” the expert clarifies.
Causes of rickets
A child grows because his bones get bigger. For new bone tissue to form in the growth cartilages, calcium and phosphorus must be deposited from the diet, the absorption of which depends on a good level of vitamin D. If vitamin D is low, the bones lose consistency, become brittle and deformed.
Symptoms and consequences of rickets
«With clinical examination, we see that children with rickets have delayed growth and bone deformities,» explains Dr. García-Dihinx, who lists them: «Their knees bend – in genu varus or genu valgus -, their wrists and ankles widen or they have costal rosary – a kind of bulging on the ribs -. In babies, the so-called craniotabes appears, where the skull bone bends when touched, like a ping pong ball.” In addition, the expert concludes, they may have bone pain.
Diagnosis of rickets
A good diagnosis of rickets requires analysis and x-rays. García-Dihinx points out that they should check that 25-hydroxyvitamin D (or calcidiol) is very low (less than 8 or 10 nanograms / milliliter), check that alkaline phosphatase is high and phosphorus is low. “Calcium can vary,” points out the doctor, who explains that when PTH or hyperparathyroid hormone is elevated, it causes phosphorus to be eliminated through the urine and prevents calcium from being lost. “That’s why, at the beginning, it can be normal and, at the end, it is already low,” he explains.
The rickets x-ray – normally, wrist and knee – allows us to detect widening and fraying of the metaphyses, “a kind of irregularity and loss of definition in the line of calcification along which the growth plate widens,” the expert clarifies.
Rickets and diet, their close relationship
«If we talk about rickets in infants, breast milk has vitamin D but very little and, therefore, it must be supplemented with drops. Formula milk is fortified,» explains Jorge García-Dihinx.
For him, the winner among foods with vitamin D is oily fish. “Sardines, small blue fatty fish that have accumulated little mercury, can be taken every day, as can mackerel, herring or anchovies,” he recommends and assures that taking sardines every day does not require supplementation with vitamin D. Another food from which to obtain the benefits of vitamin D is egg yolk, “one of the most nutritious foods that exist.”
Regarding calcium, the doctor points out: Cheese is a very rich source of this mineral and hardly has lactose, which is interesting for intolerant people.
The most bioavailable form of calcium is also in the sardine with its spine, as well as in many vegetables, such as broccoli, collard greens or kale, and spinach. There is also calcium in legumes – chickpeas, beans – and in nuts and seeds. In addition, there are many foods fortified with calcium, such as fortified yogurts and many vegetable drinks.
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Rickets treatment
Jorge García-Dihinx describes, step by step, what the treatment of deficiency rickets is:
«You must supplement with vitamin D and calcium. First, a significant dose of vitamin D, at least 2,000 units daily for infants and between 3,000 and 6,000 for children over one year old, for six to twelve weeks. To this, add calcium, either with a dairy diet or in the form of drugs, ensuring 30 to 75 milligrams per kg of weight per day. If not, there is no answer.»
After four to six weeks, check calcium, phosphorus, alkaline phosphatase and PTH, as well as a control x-ray (after two months) to check metaphyseal improvement and that the child is growing well. Once the child has been supplemented with these doses of vitamin D (which are almost ten times the normal amount), a minimum of 400 to 1000 units per day must be maintained for the rest of the year.
«Sometimes, we give hospitalized children an initial megadose, what is called stoss therapy, which is 100,000 and 300,000 units of vitamin D at one time. Sometimes, up to half a million. There is no risk of toxicity because the levels from which they start are very low and it accumulates in the fatty tissue, being released slowly,» he concludes.
Sun exposure and lifestyle
The expert explains that only the high sun is capable of generating vitamin D. Given the latitude of Spain, this is possible only in spring and summer (from the end of March to the end of October). “Therefore, the ideal is the progressive exposure of children to the sun from February or March, to generate a progressive adaptation to the sun and so that they do not burn when the high spring sun arrives,” he points out and describes how to act:
«In spring and summer, children should expose themselves for 10 or 20 minutes to the soft morning sun, whose infrared will prepare the skin for the high midday sun. Then, do an exposure at midday that lasts ten to twenty minutes, depending on the pause in your Fitzpatrick-type photo so as not to burn, and do it without cream, better with natural measures such as clothing or shade. These generate exposures for 80% of the Vitamin D. After thirty minutes, hardly any vitamin D is produced.»
When night comes, the expert says, you should avoid screens or artificial lights and use incandescent bulbs, candles and natural light until it gets dark (in spring and summer it is light until almost 10). “That is, taking care of the circadian rhythms of light and darkness,” he concludes.
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Prevention of rickets: practical keys
For García-Dihinx it is clear: systematic supplementation with vitamin D must be given to all children in their first year of life, specifically, a minimum of 400 units daily. «And, although it is not officially prescribed, I recommend continuing until the age of fifteen in the autumn and winter months. The dose? Between 1,000 and 3,000 units daily. But, above all, do not stop supplementing infants in the first year of life,» he says.
You should also monitor whether they are getting enough calcium, considering it crucial that they consume dairy products. «In the case of vegan families, yogurts and vegetable drinks fortified with calcium. And for children with allergies to milk protein, a hydrolyzed formula that has calcium,» he concludes.
Frequently asked questions about rickets
Can rickets appear in adults?
Yes, and it’s called osteomalacia. It is a decrease in bone mineralization whose most common cause is a deficiency of vitamin D but also due to a lack of calcium in the diet, due to a congenital resistance to the action of vitamin D and due to a phosphate deficiency due to greater kidney loss.
What are the at-risk populations?
Extremely premature or very dark-skinned children. For example, Arab children whose Spanish sun does not generate vitamin D and who have breastfed exclusively without supplementing with vitamin D drops. Their skin tone needs a sun like that of Africa; Here they do not generate enough vitamin D and they must be supplemented from September to May.
Is rickets reversible?
With adequate treatment it can be reversed but you have to do a review and follow the recommendations of experts such as supplementation, nutrition and sun exposure.
What is the difference between rickets and osteoporosis?
Both are metabolic bone diseases where bone mass decreases. In osteoporosis the bone is properly mineralized but there is less. Osteomalacia is a quality problem because the bone does not mineralize properly.
What should I do if my child doesn’t want foods rich in calcium?
Jorge García-Dihinx recommends that, if the child is not going to drink dairy products or calcium sources, they should be supplemented with elemental calcium (tablets or pharmacy syrups) and try to give them between 30 and 75 milligrams per kg per day, divided into two or three doses, without forgetting vitamin D.
The ALDI Council
Outdoor sports are good at any age. Much more so during childhood, since sunlight reduces the risk of vitamin D deficiencies.
Jorge García Dihinx. Jorge García-Dihinx was a pediatrician, specialist in gastroenterology and child nutrition at the San Jorge Hospital in Huesca. Trained at the Miguel Servet Children’s Hospital in Zaragoza, he stood out for his work in childhood obesity and his defense of healthy lifestyle habits, respect for circadian rhythms and low carb nutrition. Passionate Pyrenees and mountain meteorologist, he died in December 2025 in the Aragonese Pyrenees while practicing mountain skiing.
