Medication Summary

Treatment for rickets is with cholecalciferol, which may be gradually administered over several months or in a single-day dose.^[7]The single-day therapy avoids problems with compliance and may be helpful in differentiating nutritional rickets from familial hypophosphatemia rickets (FHR). In nutritional rickets, the phosphorous level rises in 96 hours and radiographic healing is visible in 6-7 days. Neither happens with FHR.

Vitamin D is well stored in the body and is gradually released over many weeks. Because both calcitriol and calcidiol have short half-lives, they are unsuitable; they would bypass the natural physiologic controls of vitamin D synthesis.

Class Summary

Vitamin D is a fat-soluble vitamin used to prevent or treat vitamin D deficiency.

Cholecalciferol (Vitamin D3, Ddrops Kids, Delta-D3)

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For treatment of rickets, cholecalciferol can be given in a single-day dose of 15,000 mcg (600,000 U), which is usually divided into 4 or 6 oral doses. An intramuscular injection is also available.

An alternative regimen is to give 125-250 mcg (5000-10,000 U) daily for 2-3 months until healing is well established and the alkaline phosphatase concentration is approaching the reference range. Because this gradual method requires daily treatment, success depends on compliance.

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Shah BR, Finberg L. Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr. 1994 Sep. 125(3):487-90. [QxMD MEDLINE Link].
Dabas A, Dabas V, Dabla PK, et al. Daily versus weekly oral vitamin D3 therapy for nutritional rickets in Indian children: A randomized controlled open-label trial. Br J Nutr. 2022 May 13. 1-23. [QxMD MEDLINE Link].
Thacher TD, Smith L, Fischer PR, Isichei CO, Cha SS, Pettifor JM. Optimal Dose of Calcium for Treatment of Nutritional Rickets: A Randomized Controlled Trial. J Bone Miner Res. 2016 Nov. 31 (11):2024-2031. [QxMD MEDLINE Link].
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Media Gallery

Findings in patients with rickets.
Anteroposterior and lateral radiographs of the wrist of an 8-year-old boy with rickets demonstrates cupping and fraying of the metaphyseal region.
Radiographs of the knee of a 3.6-year-old girl with hypophosphatemia depict severe fraying of the metaphysis.
Radiograph in a 4-year-old girl with rickets depicts bowing of the legs caused by loading.

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Author

Steven M Schwarz, MD, FAAP, FACN, AGAF Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American Association for Physician Leadership, New York Academy of Medicine, Gastroenterology Research Group, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Frank R Greer, MD Professor of Pediatrics, University of Wisconsin School of Medicine; Professor (Affiliate) of Nutritional Sciences, University of Wisconsin College of Agriculture and Life Sciences; Attending Physician in Neonatology, Center for Perinatal Care, Meriter Hospital

Frank R Greer, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society

Disclosure: Nothing to disclose.

Laurence Finberg, MD Clinical Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine and Stanford University School of Medicine

Laurence Finberg, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: Academy of Nutrition and Dietetics, American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Nestle<br/>Serve(d) as a speaker or a member of a speakers bureau for: Nestle<br/>Received income in an amount equal to or greater than $250 from: Nestle.