Rickets resurgence: Disease makes a comeback

U.S. health officials say lack of sunlight and too little milk are contributing to a resurgence of rickets

By Christy Oglesby
CNNfyi

ATLANTA, Georgia (CNN) -- Societal and environmental changes such as long commutes, smog and day care are contributing to the resurgence of childhood rickets -- a bone softening disease that health officials thought they had all but eliminated 70 years ago.

Atlanta health officials have detected about 10 cases of the rare disease, said Dr. Norman Carvalho of Children's Healthcare of Atlanta, a children's hospital. But there may be more, he said, because the disease's rarity may make it unrecognizable to physicians. And if doctors do ascertain that a patient has rickets, they are not required to report it to the state health department.

Carvalho was the leader in a Georgia study on malnutrition that will appear in the April issue of the journal Pediatrics. The study, conducted from 1997 to 1999, found that about one in 200,000 children in Georgia is hospitalized with rickets.

Because the disease had become so rare and it is not one that doctors must report, there are no national figures or earlier numbers for comparison. But health professionals are exploring methods to improve tracking the disease.

Nutritional rickets, the kind the Georgia doctors tracked, is caused by a lack of vitamin D and the lack of calcium or phosphate. Not many foods are rich in vitamin D, Carvalho said. The primary source of the nutrient is milk, because the dairy industry began adding the vitamin in the 1930s to prevent the disease. Other vitamin D sources include sunshine and cod liver oil. Sunlight stimulates the body to produce vitamin D.

"Many people think cheese and yogurt have vitamin D, but they don't," Carvalho said.

There are other forms of rickets caused by genetic problems or kidney and liver malfunction that prevent the body from absorbing or metabolizing vitamin D.

The increasing number of breast-feeding mothers might contribute to the rickets upswing, Carvalho said, because breast milk does not contain vitamin D. Many parents also are choosing soy and rice-based milk for their infants once they are weaned. Those products also lack vitamin D, and parents might need to supplement their infant's diet with vitamin D to stave off rickets, Carvalho said.

Children of vegan parents are very much at risk of rickets if their parents do not supplement their diet with the vitamin.

Melanin matters

Grueling work schedules and long commutes prevent many parents from giving their infants and toddlers the sunshine time they need, Carvalho said.

Doctors do not recommend a specific amount of time for children to spend in the sun, Carvalho said, nor do physicians advocate prolonged sun exposure because of skin cancer risks.

Low melanin levels allow fair-skinned people to better absorb vitamin D from the sun. Conversely, people of African and Asian descent may have more melanin in their skin, which offers protection from skin cancer but inhibits the ability to absorb the vitamin.

The rickets increase is most significant among black infants who were breast-fed.

Bianca Arrington's infant son, Japhet Springer, was diagnosed with rickets after a series of seizures

Bianca Arrington, a black patient of Carvalho's, told the Associated Press that no one told her about the importance of vitamin D as she was nursing her son. The baby boy was diagnosed with rickets after he suffered a series of seizures. "Never once did anyone mention vitamin D when I was pregnant," Arrington said. "I knew my diet was very important. But I'd never heard of rickets before."

Study: Sodas linked to obesity
February 15, 2001
New guidelines released on vitamin, mineral supplements
January 9, 2001
Vitamin D being studied as anti-cancer drug
August 22, 2000
NIH panel issues consensus report on osteoporosis
March 29, 2000

MEDLINEplus - Rickets
Vitamin D Home Page
WHO Child Health and Development

Note: Pages will open in a new browser window

External sites are not endorsed by CNN Interactive.