4.2 Osteomalacia & Rickets

Osteomalacia and rickets are basically the same condition and are a consequence of poor bone mineralisation. Both conditions result in a softening of the bones due to insufficient levels of phosphate and calcium deposited within the bones. In adults, the condition is called osteomalacia and in children, the more severe and slightly different version is called rickets.

In the case of osteomalacia, the poor bone mineralisation can be a result of several factors similar to those outlined previously in osteoporosis. There can be an elevation in parathyroid hormone for example due to hyperparathyroidism, reduced calcium intake, or poor calcium utilisation and decreased vitamin D levels. It very often starts as aches and pains in the lower part of the spine and into the thighs, before eventually spreading into the arms. This often leads to difficulties in walking properly which manifests as a waddling gait. Bones can bend, and flattening of the pelvis can occur.

Rickets is, in essence, the same issue – poor bone mineralisation, but it occurs before epiphyseal closure – the cessation of bone growth. Reduced mineralisation at this growth stage can have much more severe and noticeable consequences. The weight bearing down on the softened bones can lead to deformities. In toddlers, this can often be seen as bowed legs, and in older children as knock-knees. It can also result in cranial, spinal and pelvic deformities, as well as growth disturbances. Now, in some parts of the world, rickets is very common. This is because it is most often associated with severe malnutrition. It is, after all, a vitamin D deficiency issue. However, in recent years the UK has seen a vast increase in the number of cases of rickets in children from all backgrounds. Why is this? Well, much of this has come from the overuse of sunblock. Don’t worry, we are not for a minute suggesting throwing sunscreen away, but perhaps the extent to which sunblock is used should be reconsidered. We all need some sunlight exposure, that’s for sure. Just a small amount, around 10 minutes a day can help us to synthesise vitamin D. Applying sunblock before having any sun exposure affects the synthesis of Vitamin D. The other part of the picture of rickets resurfacing is that the few food sources of vitamin D are seldom eaten by the majority of the public. Full fat milk, butter, and oily fish like sardines, herrings, and salmon are all rich sources, and aside from salmon, the others are not very widely consumed at all. Skimmed and semi-skimmed milk products have very little Vitamin D, as it is found in the fat component of dairy. Here at Sano School of Culinary Medicine, we advocate full-fat dairy products in moderation, as opposed to semi-skimmed or low-fat alternatives.