Rickets

Last reviewed: 21 Apr 2022
Last updated: 16 Jun 2021

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
More key diagnostic factors

Other diagnostic factors

  • bone pain
  • growth retardation
  • delayed achievement of motor milestones
  • bony deformities
  • muscle weakness
  • carpopedal spasm
  • tetany
  • numbness or paresthesias
  • hypocalcemic seizures
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations 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
More 1st investigations to order

Investigations to consider

  • 1,25-dihydroxyvitamin D levels (calcitriol)
More investigations to consider

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.

  • Rickets images
  • Differentials

    • Hypophosphatasia
    • Metaphyseal dysostoses
    • Blount syndrome
    More Differentials
  • Guidelines

    • Global consensus recommendations on prevention and management of nutritional rickets
    • Vitamin D - screening and supplementation during pregnancy
    More Guidelines
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