Rickets Due to Severe Vitamin D and Calcium Deficiency

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Rickets
Figure 1. Bilateral bowing of the legs upon first presentation.

Rickets, a growing concern during the Covid-19 pandemic

Rickets is defined as a deficiency in the mineralization of bone. Caused because of a lack of sunlight exposure and calcium or vitamin D deficiency in children. Efforts to eradicate rickets currently include adequate exposure to sunlight and fortification of food and milk with vitamin D. However, there has been growing concern that Covid-19 and an inadequate exposure to sunlight because of movement restrictions. This has further led to an increase in the incidence of rickets.

In a similar case, a 22-month-old girl presented to the primary care clinic with abnormal gait and bowing of legs. The patient lived in an apartment in Selangor, Malaysia and had a history of inadequate exposure to sunlight because of government imposed movement control. The patient’s calcium intake was also poor as she was intolerant to formula milk and did not have any other dairy products in her diet. Investigations were significant for severe hypocalcemia and low levels of vitamin D.  

The patient presented to an urban academic primary care clinic in November 2020 with obvious signs of abnormalities

Her mother was concerned about the shape of her child’s legs and abnormal gait. Initially, the family noticed these signs a few months before the visit. According to the parents, she started walking at 13 months of age with no obvious signs of abnormalities. Similarly, the child was otherwise active at home. There was no significant medical history of seizures, fever, diarrhea, or other systemic problems. Her immunizations were up to date, and she had no significant past medical history. Neither did she have a history of rickets or any other genetic diseases in her family. However, further questioning revealed that the patient’s calcium intake was poor, and she could not tolerate formula milk or any other dairy products. Investigations were significant for hypocalcemia and low levels of vitamin D.

Based on these findings, the patient was diagnosed with nutritional rickets. Doctors prescribed the patient with oral calcium and vitamin D supplementation. Her vitamin D levels, and bilateral bowed legs showed significant improvement at her 6-month follow-up. This case highlights the importance of addressing the possible effects of inadequate sunlight exposure, leading to vitamin D deficiency and rickets in children during the Covid-19 pandemic.

Source: American Journal of Case Reports

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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