Can vitamin B deficiency cause rickets in a pediatric patient?

Vitamin B Does Not Cause Rickets

Vitamin B deficiency does not cause rickets in pediatric patients. Rickets is caused by deficiencies in vitamin D, calcium, or phosphate metabolism—not vitamin B deficiency 1, 2.

The Actual Causes of Rickets

Rickets can be classified into two major categories based on the underlying metabolic disturbance 2:

Calcipenic Rickets (Vitamin D or Calcium Deficiency)

• Vitamin D deficiency rickets is the most common form worldwide, resulting from inadequate vitamin D intake combined with insufficient sunlight exposure 1, 3
• Approximately 40% of infants and toddlers aged 8-24 months have vitamin D insufficiency, with prolonged breastfeeding without supplementation being a critical risk factor 1
• Dietary calcium deficiency (typically <300 mg/day) can also cause rickets, particularly in tropical countries with malnourished populations 4, 3
• The American Academy of Pediatrics recommends a minimum daily intake of 400 IU of vitamin D for all infants beginning soon after birth to prevent rickets 5

Phosphopenic Rickets (Phosphate Metabolism Disorders)

• X-linked hypophosphatemia (XLH) represents approximately 80% of hereditary hypophosphatemic rickets cases 1, 4
• Vitamin D-dependent rickets type 1A (VDDR-1A) represents about 20% of hypophosphataemic rickets cases and is caused by mutations in CYP27B1 6
• These genetic forms require specialized treatment with active vitamin D metabolites and phosphate supplementation 1, 6

Clinical Presentation and Diagnosis

The characteristic features of rickets include 1, 3:

• Widening, fraying, and cupping of the metaphyses on radiographs
• Clinical manifestations: swollen wrist and ankle joints, rachitic rosary, soft skull, bowing deformities
• Elevated alkaline phosphatase and parathyroid hormone levels
• Low serum 25-hydroxyvitamin D and/or low phosphate levels

Common Pitfall: Vitamin B Confusion

There is no established connection between any B vitamin deficiency and rickets. While riboflavin (vitamin B2) deficiency causes oral manifestations like cheilosis and angular stomatitis 7, it does not affect bone mineralization or cause rickets. The confusion may arise from the similar naming convention ("vitamin B" vs. "vitamin D"), but these are entirely different nutrients with distinct physiological roles.

Treatment Approach

For nutritional rickets 4, 3:

• High-dose cholecalciferol or ergocalciferol daily for minimum 12 weeks
• Combined calcium supplementation (1 gram daily for adolescents)
• Expected healing time: 3-9 months
• Lifelong maintenance supplementation thereafter

If a child with apparent rickets fails to respond to standard vitamin D supplementation, suspect genetic forms like VDDR-1A or XLH and pursue molecular genetic testing 6.