Rickets

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Teoría 
Diagnóstico 
Manejo 
Seguimiento 
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Última revisión: 21 Sep 2025

Última actualización: 13 May 2025

Rickets is deficient mineralization at the growth plate of long bones, resulting in faltering growth. If the underlying condition is not treated, bone deformity occurs, typically causing bowed legs and thickening of the ends of long bones.

Rickets only occurs in growing children before fusion of the epiphyses, and typically affects the wrists, knees, and costochondral junctions.

Rickets occurs primarily as a result of a nutritional deficiency of vitamin D, but can be associated with nutritional deficiencies of calcium or phosphorus. Hypophosphatemic rickets is a common genetic cause of rickets.

The mainstay of treatment is to correct vitamin D deficiency and to ensure adequate calcium intake.

Vitamin D deficient rickets can be prevented in many cases by ensuring that children and pregnant women have sufficient vitamin D and calcium intake.

Definición

Rickets refers to changes caused by deficient mineralization at the growth plate of long bones. Osteomalacia refers to impaired mineralization of the bone matrix. Rickets and osteomalacia usually occur together while the growth plates are open. Rickets only occurs in growing children before fusion of the epiphyses; osteomalacia can occur after the growth plates have fused.[1][2]

Rickets can manifest in childhood at the distal forearm, knee, and costochondral joints, as these are sites of rapid bone growth, where large quantities of calcium and phosphorus are required for mineralization.[3] Characteristic features include widening of the bones at the wrists and knees, bowing of the legs, spine deformities, fractures, bone pain, and dental abnormalities.[4]

Anamnesis y examen

Principales factores de diagnóstico

history of breast-feeding
history of inadequate sunlight exposure
history of calcium deficiency
history of phosphate deficiency

Todos los datos

Otros factores de diagnóstico

bone pain
growth faltering
delayed achievement of motor milestones
bony deformities
muscle weakness
carpopedal spasm
tetany
numbness or paresthesias
hypocalcemic seizures

Todos los datos

Factores de riesgo

age 6 to 23 months
inadequate sunlight exposure
breast-feeding
darker skin complexion
calcium deficiency
phosphate deficiency
family history of rickets
antacids, loop diuretics, corticosteroids, or anticonvulsants

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

radiograph of a long bone
serum calcium
serum inorganic phosphorus
serum parathyroid hormone level
25-hydroxyvitamin D levels (calcidiol)
alkaline phosphatase and liver function tests
serum creatinine and blood urea nitrogen
urinary calcium and phosphorus

Todos los datos

Pruebas diagnósticas que deben considerarse

1,25-dihydroxyvitamin D levels (calcitriol)

Todos los datos

Algoritmo de tratamiento

Agudo

symptomatic hypocalcemia

En curso

calcium-deficient rickets: vitamin D deficiency

calcium-deficient rickets: calcium deficiency

calcium-deficient rickets: pseudovitamin D deficiency

calcium-deficient rickets: vitamin D resistance

hypophosphatemic rickets: X-linked

hereditary hypophosphatemic rickets with hypercalciuria

hypophosphatemic rickets: tumor-induced

Colaboradores

Autores

Carlos Palacio, MD, MPH, FACP

Professor of Medicine

Associate Program Director

Internal Medicine Residency

Department of Medicine

University of Florida College of Medicine

Jacksonville

Divulgaciones

CP declares that he has no competing interests.

Firas Warda, MD

Endocrinology Fellow

Division of Endocrinology, Diabetes, and Metabolism

Department of Medicine

University of Florida College of Medicine

Jacksonville

Disclosures

FW declares that he has no competing interests.

Acknowledgements

Professor Carols Palacio and Dr Firas Warda would like to gratefully acknowledge Dr Robert Olney, a previous contributor to this topic.

Disclosures

RO declares that he has no competing interests.

Peer reviewers

Phil Fischer, MD

Professor of Pediatrics

Mayo Clinic

Rochester

Disclosures

PF declares that he has no competing interests.

Zulf Mughal, MD

Consultant in Paediatric Bone Disorders

Department of Paediatric Endocrinology

Royal Manchester Children's Hospital

Disclosures

No disclosures

Arshag Mooradian, MD

Professor of Medicine

University of Florida College of Medicine

Jacksonville

Disclosures

AM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 495: vitamin D: screening and supplementation during pregnancy. Jul 2011 [internet publication].Full text

Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016 Feb;101(2):394-415.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Hypophosphatasia
- Metaphyseal dysostoses
- Blount syndrome
More Differentials
Guidelines
- Rickets: standard treatment guidelines
- Global consensus recommendations on prevention and management of nutritional rickets
More Guidelines
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Rickets

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

symptomatic hypocalcemia

calcium-deficient rickets: vitamin D deficiency

calcium-deficient rickets: calcium deficiency

calcium-deficient rickets: pseudovitamin D deficiency

calcium-deficient rickets: vitamin D resistance

hypophosphatemic rickets: X-linked

hereditary hypophosphatemic rickets with hypercalciuria

hypophosphatemic rickets: tumor-induced

Colaboradores

Autores

Carlos Palacio, MD, MPH, FACP

Divulgaciones

Firas Warda, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Phil Fischer, MD

Disclosures

Zulf Mughal, MD

Disclosures

Arshag Mooradian, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

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