When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Rickets

Last reviewed: 9 Apr 2025
Last updated: 21 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of breast-feeding
  • history of inadequate sunlight exposure
  • history of calcium deficiency
  • history of phosphate deficiency
Full details

Other diagnostic factors

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

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests to consider

  • 1,25-dihydroxyvitamin D levels (calcitriol)
Full details

Treatment algorithm

ACUTE

symptomatic hypocalcemia

ONGOING

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

Contributors

Authors

Carlos Palacio, MD, MPH, FACP
Carlos Palacio

Professor of Medicine

Associate Program Director

Internal Medicine Residency

Department of Medicine

University of Florida College of Medicine

Jacksonville

FL

Disclosures

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

FL

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

MN

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

UK

Disclosures

No disclosures

Arshag Mooradian, MD

Professor of Medicine

University of Florida College of Medicine

Jacksonville

FL

Disclosures

AM declares that he has no competing interests.

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.
  • Rickets images
  • 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
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer