Introduction: Rickets is a disease in pediatric patients defined as a condition in which the mineralization of epiphyseal plates is defective. A nutritional deficiency in Vitamin D, calcium, or phosphate causes acquired rickets. Rickets is a condition that is most predominantly present in developing countries in which poor sun exposure, high altitude, and breastfeeding are some predisposing factors that may be present.
Case Study: A fifteen-month-old male African-American patient presented to the pediatrician to establish care. Per the report of the patient’s parents, a previous pediatrician had diagnosed the patient with failure to thrive, anemia, and hepatosplenomegaly. Upon physical examination, the patient was determined to be in the < 1st percentile for height and 8th percentile for weight. Frontal bossing was also observed. Hemoglobin level was measured in the office and determined to be 6.3 g/dL. At this point, the patient was sent to a pediatric emergency department for continued treatment and workup. At the emergency department, the patient was given a blood transfusion and had lab studies completed revealing iron deficiency anemia and decreased levels of Vitamin D, calcium, and phosphate, leading to the additional diagnosis of rickets. These studies, paired with X-ray images of the patient’s shoulders and wrists, further confirmed the diagnosis. The patient was seen in the outpatient pediatric setting after the hospitalization, where he is being managed on supplementation of calcium carbonate suspension, polysaccharide iron complex/ novaferrum drops, and cholecalciferol drops with referral to endocrinology, hematology, and dietetics.
Discussion: This case serves as an example of how the diagnosis of rickets is not to be missed, especially in developed countries like the United States. This case is osteopathically relevant as the tenet of structure and function being reciprocally interrelated was considered in the treatment plan. If this patient were to continue on the path he was currently on with no supplementation or intervention, his bones would continue to develop abnormally, negatively affecting the function that is intended.
