Restrictive eating may up risk for rickets in children

The restrictive eating habits of many children and teens with autism spectrum disorders (ASD) put them at increased risk for rickets due to vitamin D deficiency, according to a study by researchers in the United States. Rickets can cause bone softening and deformities, delayed growth, muscle weakness, delayed motor skills, and pain in the lower body.

Mohamed Said and colleagues performed a retrospective chart review at a children’s hospital to identify patients with ASD who exhibited symptoms of nutritional rickets. They included all patients who had clinical findings indicative of rickets, laboratory evidence of vitamin D deficiency with or without low calcium levels (a side effect of vitamin D deficiency), and radiographic findings consistent with rickets. They also collected information on where the children lived, their symptoms, their dietary patterns, their clinical examination findings, the results of laboratory and imaging tests, and their case management and outcomes.

The researchers identified 11 patients with rickets, ranging from four to 16 years of age. All of them resided in low-income neighborhoods. All had extremely low vitamin D levels, eight had very low serum calcium (leading to seizures in three children), and seven had musculoskeletal problems. Most of the children improved with nutritional treatment alone. However, significant complications included bilateral fractures of the femur and deformities severe enough to require surgery.

The researchers comment, “Older children and adolescents with ASD and highly selective diets, particularly those living in very low-opportunity neighborhoods, may develop severe nutritional rickets with presentations ranging from subtle gait changes and progressive valgus deformity [“knock knees” or related bone and joint misalignments] to hypocalcemic seizures. Orthopedists should maintain a high index of suspicion for metabolic bone disease in this population and obtain a focused dietary history, targeted laboratory testing, and radiographs to enable timely treatment and prevent morbidity.”

The new research follows previous studies linking restrictive eating habits to an increased risk for beriberi, due to vitamin B1 deficiency; scurvy, due to low vitamin C levels (see ARRI Vol. 37, No. 1); and blindness, due to low vitamin A levels (see ARRI Vol. 38, No. 4).

Citations

“Orthopaedist beware: severe nutritional rickets and autism spectrum disorder,” MohamedSaid, Alexandra Falkenberg, Leila Alvandi, Edina Gjonbalaj, Alexa J. Karkenny, and Melinda S. Sharkey, Journal of the Pediatric Orthopaedic Society of North America, August 2026 (free online). Address: Melinda Sharkey, Montefiore Einstein Department of Orthopedic Surgery, 3400 Bainbridge Ave., Bronx, NY 10467, [email protected].