Rickets

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 30 Sep 2025

Last updated: 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.

Определение

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]

Анамнез и осмотр

Ключевые диагностические факторы

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

Полная информация

Другие диагностические факторы

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

Полная информация

Факторы риска

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

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

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

Полная информация

Исследования, проведение которых нужно рассмотреть

1,25-dihydroxyvitamin D levels (calcitriol)

Полная информация

Алгоритм лечения

Острый

symptomatic hypocalcemia

ПРОДОЛЖЕНИЕ

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

Составители

Авторы

Carlos Palacio, MD, MPH, FACP

Professor of Medicine

Associate Program Director

Internal Medicine Residency

Department of Medicine

University of Florida College of Medicine

Jacksonville

Раскрытие информации

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

Раскрытие информации

FW declares that he has no competing interests.

Выражение благодарностей

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

Раскрытие информации

RO declares that he has no competing interests.

Рецензенты

Phil Fischer, MD

Professor of Pediatrics

Mayo Clinic

Rochester

Раскрытие информации

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

Раскрытие информации

No disclosures

Arshag Mooradian, MD

Professor of Medicine

University of Florida College of Medicine

Jacksonville

Раскрытие информации

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.

Список литературы

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.

Основные статьи

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

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.Полный текст Аннотация

Статьи, указанные как источники

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

Отличия
- Hypophosphatasia
- Metaphyseal dysostoses
- Blount syndrome
Больше Отличия
Рекомендации
- Rickets: standard treatment guidelines
- Global consensus recommendations on prevention and management of nutritional rickets
Больше Рекомендации
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Rickets

Summary

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

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

Составители

Авторы

Carlos Palacio, MD, MPH, FACP

Раскрытие информации

Firas Warda, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Phil Fischer, MD

Раскрытие информации

Zulf Mughal, MD

Раскрытие информации

Arshag Mooradian, MD

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

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

Отличия

Рекомендации

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice