rachitic

Rachitic is an adjective referring to rickets, a pediatric disorder characterized by defective mineralization of growing bones, most often due to vitamin D deficiency. Rachitic bone changes arise from impaired mineralization at the growth plate, leading to metaphyseal cupping and fraying, soft bones, and deformities. While nutritional vitamin D deficiency is common, rachitic conditions can also result from phosphate disorders, malabsorption, liver or kidney disease, or medications that disrupt vitamin D activation.

In children, clinical features include delayed growth, bone pain, swelling at the costochondral junctions (rachitic rosary), craniotabes, frontal bossing, dental problems, and bowing of the legs.

Diagnosis combines history, physical examination, imaging, and laboratory tests. X-rays show metaphyseal cupping and fraying and physeal widening. Labs often reveal low or normal calcium and phosphate, elevated alkaline phosphatase, and secondary hyperparathyroidism; 25-hydroxyvitamin D is usually low. In some phosphate-wasting disorders, phosphate is low with normal calcium and variable vitamin D levels.

Management focuses on correcting vitamin D and calcium deficiencies and addressing underlying causes. This may involve vitamin D supplementation (vitamin D2 or D3), calcium supplementation, and prudent sunlight exposure. In phosphate-wasting rickets, phosphate and active vitamin D (calcitriol) are used. With early treatment, many children achieve normal growth; persistent deformities may require orthopedic intervention. Prevention includes adequate prenatal and childhood vitamin D intake and monitoring at-risk populations.