Which vitamin deficiency results in rickets? A comprehensive look at bone health

October 25, 2025 •

4 min read

Globally, about 1 billion people have a vitamin D deficiency, and a severe deficiency can result in the bone-weakening disease known as rickets in children. This condition, once thought to be nearly eradicated in developed nations, is unfortunately seeing a resurgence, highlighting the critical importance of proper nutrition and sunlight exposure.

Quick Summary

Rickets, a condition characterized by softened and weakened bones in children, is primarily caused by a severe and prolonged lack of vitamin D. This impairs the body's ability to absorb calcium and phosphorus, leading to skeletal deformities and other symptoms. Correcting the nutritional deficit is key to treatment and prevention.

Key Points

Primary Cause: Rickets is overwhelmingly caused by a significant deficiency of Vitamin D, which is essential for the body to absorb calcium and phosphorus.
Risk Factors: High-risk groups include exclusively breastfed infants, individuals with darker skin pigmentation, those living in northern latitudes, and people with limited sunlight exposure.
Crucial Minerals: While vitamin D is key, deficiencies in dietary calcium and phosphorus can also lead to or exacerbate rickets.
Classic Symptoms: The disease is identifiable by skeletal deformities like bowed legs, as well as bone pain, muscle weakness, and stunted growth.
Prevention is Key: Ensuring adequate vitamin D intake through fortified foods, supplements, and safe sun exposure is the most effective way to prevent nutritional rickets.
Treatment: Nutritional rickets is treated with vitamin D and calcium supplements, with a high success rate, though severe cases may require orthopedic intervention.

The Critical Role of Vitamin D

At the core of bone health is a delicate balance of minerals, primarily calcium and phosphorus. Vitamin D acts as a crucial facilitator, helping the body absorb these essential minerals from the food consumed. When there is a significant and prolonged deficiency of this vitamin, the body struggles to maintain adequate mineral levels, disrupting the normal mineralization process of growing bone tissue. This results in the hallmark symptoms of rickets, including soft, weakened bones that are susceptible to bending and breaking.

Beyond just nutritional intake, the body can produce its own vitamin D when the skin is exposed to direct sunlight. However, factors such as geographic location (higher latitudes with less sun), increased sunscreen use, or covering up for cultural or religious reasons can limit this natural production, increasing the risk of deficiency.

Beyond Vitamin D: The Broader Nutritional Picture

While vitamin D deficiency is the most common nutritional cause, rickets can also be influenced by other factors and nutrient shortfalls.

Calcium and Phosphorus Deficiency: An inadequate dietary intake of calcium or phosphorus, even with sufficient vitamin D, can contribute to the development of rickets. Some children in parts of the world with cereal-based diets and limited dairy access have experienced rickets primarily due to low dietary calcium.
Malabsorption Syndromes: Certain medical conditions, like Celiac disease, Crohn's disease, or Cystic Fibrosis, can interfere with the body's ability to absorb fat-soluble vitamins, including vitamin D, from the intestines.
Genetic Factors: Rare genetic disorders can cause forms of rickets that are resistant to standard vitamin D treatment. These conditions affect how the body processes vitamin D or phosphate.

Identifying Rickets: Common Symptoms

Symptoms of rickets can manifest in various ways, affecting a child's bones, muscles, and overall development. Early recognition is crucial for timely intervention and better outcomes.

Skeletal Deformities: The most recognized symptom is bowed legs (genu varum) or knock-knees (genu valgum). Other deformities can include a protruding breastbone, thickened wrists and ankles, and spinal curvatures.
Bone Pain and Weakness: Children may experience pain or tenderness in their spine, pelvis, and legs, and their bones can be more prone to fractures.
Muscle Weakness and Development: Muscle hypotonia (poor muscle tone), overall muscle weakness, and delayed motor skill development can occur.
Delayed Growth: A noticeable delay in growth and overall failure to thrive is often present.
Dental Problems: Issues such as delayed tooth formation, defective enamel, and a higher risk of cavities are common in children with rickets.

Prevention and Treatment of Rickets

For most cases of nutritional rickets, a multifaceted approach combining diet, supplementation, and lifestyle changes is highly effective. Genetic forms of the disease require specialized treatment, but nutritional rickets is highly preventable.

Nutritional and Lifestyle Recommendations

Vitamin D and Calcium Supplements: Healthcare providers often prescribe high-dose vitamin D and calcium supplements to correct the deficiency rapidly. Recommendations exist for daily supplementation, particularly for infants who are exclusively breastfed.
Sunlight Exposure: Safe, moderate exposure to direct sunlight helps the skin produce vitamin D naturally. The duration of exposure for optimal vitamin D production varies based on factors like skin type, time of day, and geographic location. However, even limited exposure can contribute to vitamin D levels.
Dietary Adjustments: A balanced diet rich in vitamin D and calcium is essential. Fortified foods like milk, infant formula, cereal, and orange juice are common sources in some countries, while fatty fish, egg yolks, and certain mushrooms provide natural vitamin D.

Comparing Rickets Causes and Treatment


Feature	Nutritional Rickets (Vitamin D Deficiency)	Genetic/Hereditary Rickets (e.g., Hypophosphatemic)
Primary Cause	Inadequate vitamin D or calcium intake/absorption.	Inherited defect in phosphate or vitamin D metabolism.
Treatment	Vitamin D and calcium supplementation, dietary changes, and sunlight exposure.	Specialized treatment tailored to the specific genetic condition, potentially involving phosphate supplements and other medications.
Prognosis	Generally excellent with prompt and appropriate treatment.	Dependent on the specific disorder and management, with ongoing medical supervision often required.
Diagnosis	Blood tests (low vitamin D, low phosphorus, high alkaline phosphatase) and X-rays.	Advanced genetic testing and specialized labs, along with clinical evaluation.

Outlook and Conclusion

For most children with nutritional rickets, the outlook is very positive. With appropriate treatment, biochemical markers typically normalize within a few weeks, and skeletal changes improve over several months. In some cases, severe bone deformities may require braces or corrective surgery, but many resolve with growth after the underlying deficiency is addressed. A key takeaway is that nutritional rickets is largely preventable through proactive measures. Ensuring that pregnant women have adequate vitamin D levels and that all infants receive proper supplementation is vital. By prioritizing good nutritional habits and safe sun exposure, we can effectively combat this condition and protect the bone health of our children. You can find more information about pediatric health and vitamin D guidelines at HealthyChildren.org.

Frequently Asked Questions

The primary vitamin deficiency that causes rickets is a severe and prolonged lack of vitamin D, which is critical for the absorption of calcium and phosphorus needed for bone mineralization.

Yes, while vitamin D deficiency is the most common cause, a very low dietary intake of calcium can also lead to rickets, particularly in older children and if combined with insufficient vitamin D.

Rickets affects children whose bones are still growing, causing soft bones and skeletal deformities. Osteomalacia is the adult equivalent, where bones soften but do not typically bow because the growth plates have already closed.

To prevent rickets, ensure your child gets adequate vitamin D from fortified foods, supplements, or safe sun exposure. Infants who are exclusively breastfed should receive daily vitamin D drops, as recommended by a healthcare professional.

Yes, rare genetic disorders can affect how the body processes vitamin D and phosphate, leading to inherited forms of rickets. Certain medical conditions, like kidney disease or malabsorption syndromes, can also interfere with nutrient processing.

Common symptoms include bowed legs, bone pain or tenderness, muscle weakness, stunted growth, and thickened wrists or ankles. In infants, a soft skull and delayed motor skills may be observed.

Nutritional rickets is typically treated with high doses of vitamin D and calcium supplements, along with dietary adjustments and moderate sun exposure. In severe cases, bracing or surgery might be necessary to correct deformities.

With proper treatment, biochemical markers can improve within weeks, and skeletal healing becomes visible within months. Most children with nutritional rickets recover fully, though addressing deformities may take longer.