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- How to differentiate between calcipenic and phosphopenic rickets?
Rickets can be classified on the basis of primary abnormality in mineral homeo-
stasis as calcipenic or phosphopenic. Calcipenic rickets is due to calcium/vita-
min D deficiency or impaired vitamin D action, whereas phosphopenic rickets
is primarily due to hypophosphatemia as a consequence of renal phosphate
wasting. The differences between calcipenic and phosphopenic rickets are sum-
marized in the table given below.Parameters Calcipenic rickets Phosphopenic rickets
History Inadequate sun exposure Family history of rickets/
Poor dietary calcium intake osteomalacia
Malabsorption
Anticonvulsant therapy
Growth plate
abnormalitiesLess severe More severeDeformities Less severe More severe
Enthesopathy Absent Present
Myopathy Present Absenta
Bone pain Present Absenta
Dental abscess Absent Present
Enamel hypoplasia Present Absent
Tetany May be present Absent
Seizures May be present Absent
Osteopenia May be present Absent
Osteitis fibrosa cystica May be present Absent
Calcium Low/low to normal Normal
Phosphorous Low/normal Very low
Alkaline phosphatase Markedly elevated Elevated
Serum PTH Markedly elevated Normal to mildly elevated
aExcept in tumor-induced osteomalacia (TIO)
- What are the clinical features of rickets?
The clinical features of rickets are enlisted in the table given below.Site Clinical features
Skull Craniotabes
Frontal bossing
Dentition Delayed tooth eruption
Enamel hypoplasia
Extremities Widening of wrist
Genu valgum, genu varum
Windswept deformity
Double malleolus
Saber shin (anterior convexity of tibia)5 Rickets–Osteomalacia