Rickets

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X-ray

Osteomalacia in children; Vitamin D deficiency; Renal rickets

• Bone pain or tenderness
  • Arms
  • Legs
  • Spine
  • Pelvis
• Skeletal deformities
  • Bowlegs
  • Forward projection of the breastbone (pigeon chest)
  • Bumps in the rib cage (rachitic rosary)
  • Asymmetrical or odd-shaped skull
  • Spine deformities (spine curves abnormally, including scoliosis or kyphosis)
  • Pelvic deformities
• Increased tendency toward bone fractures
• Dental deformities
  • Delayed formation of teeth
  • Defects in the structure of teeth, holes in the enamel
  • Increased incidence of cavities in the teeth (dental caries)
  • Progressive weakness
  • Decreased muscle tone (loss of muscle strength)
• Muscle cramps
• Impaired growth
• Short stature (adults less than 5 feet tall)

A physical exam reveals tenderness or pain in the bones, rather than in the joints or muscles.

The following tests may help diagnose rickets:

• Blood tests (serum calcium) may show low levels of calcium.
  • Tetany (prolonged muscle spasm) may occur if serum levels of calcium are low.
  • Chvostek's sign may be positive (a spasm of facial muscles occurs when the facial nerve is tapped) indicating low serum levels of calcium.
• Serum phosphorus may be low.
• Serum alkaline phosphatase may be high.
• Arterial blood gases may reveal metabolic acidosis.
• Bone x-rays may show loss of calcium from bones or changes in the shape or structure of the bones.
• A bone biopsy is rarely performed but will confirm rickets.

• PTH
• Urine calcium
• Calcium (ionized)
• ALP (alkaline phosphatase) isoenzyme

Review Date: 08/18/2006
Reviewed By: Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine and Pediatrics, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.