Editing Rickets (section)

==Diagnosis==
[[File:RicketsXray.jpg|thumb|upright=1.3|Wrist X-ray showing changes in rickets. Mainly cupping is seen here.]] [[File:RicketsChestXray.jpg|thumb|upright=1.3|Chest X-ray showing changes consistent with rickets. These changes are usually referred to as "rosary beads" of rickets.]]
Rickets may be diagnosed with the help of:
* Blood tests:<ref name="NHSChoice">{{cite web| url = http://www.nhs.uk/Conditions/Rickets/Pages/Diagnosis.aspx| title = NHS Choice - Rickets Diagnoses| date = 6 June 2018}}</ref>
** Serum [[calcium]] may show low levels of calcium, serum [[phosphorus]] may be low, and serum [[alkaline phosphatase]] may be high from bones or changes in the shape or structure of the bones. This can show enlarged limbs and joints.
* A [[bone density]] [[DXA|scan]] may be undertaken.<ref name="NHSChoice"/>
* [[Projectional radiography|Radiography]] typically show widening of the zones of provisional calcification of the [[metaphysis|metaphyses]] secondary to unmineralized osteoid. Cupping, fraying, and splaying of metaphyses typically appears with growth and continued weight bearing.<ref name="CheemaGrissom2003">{{cite journal | vauthors = Cheema JI, Grissom LE, Harcke HT | title = Radiographic characteristics of lower-extremity bowing in children | journal = Radiographics | volume = 23 | issue = 4 | pages = 871–880 | year = 2003 | pmid = 12853662 | doi = 10.1148/rg.234025149 | doi-access =  }}</ref> These changes are seen predominantly at sites of rapid growth, including the proximal humerus, distal radius, distal femur and both the proximal and the distal tibia. Therefore, a skeletal survey for rickets can be accomplished with anteroposterior radiographs of the knees, wrists, and ankles.<ref name="CheemaGrissom2003"/>

In [[Veterinary medicine|veterinary practice]], rickets, [[osteodystrophy]] and mineral metabolism disorders are diagnosed using an ultrasound echosteometer in the design [[Орлов, Матвей Михайлович|М.М. Orlov]] and [[Савинков, Алексей Владимирович|А.V. Savinkov]].<ref>{{Cite web|url=https://patents.google.com/patent/RU2779304C1/ru|title=Ветеринарный ультразвуковой эхоостеометр для оценки физических характеристик костей скелета животных при их функциональных и патологических изменениях | trans-title = Veterinary ultrasonic echo osteometer for the assessment of physical characteristics of the bones of the skeleton of animals with their functional and pathological changes | language = ru }}</ref><ref>{{Cite web|url=https://patenton.ru/patent/RU2779304C1|title=Ветеринарный ультразвуковой эхоостеометр для оценки физических характеристик костей скелета животных при их функциональных и патологических изменениях | trans-title = Veterinary ultrasonic echo osteometer for the assessment of physical characteristics of the bones of the skeleton of animals with their functional and pathological changes | language = ru }}</ref><ref>{{cite web | url = https://projects.2035.university/project/portativnyj-veterinarnyj-ultrazvukovoj-ehoosteometr-dla-ocenki-fiziceskih-harakteristik-kostej-skeleta-zivotnyh-pri-ih-funkcionalnyh-i-patologiceskih-izmeneniah | title = ПОРТАТИВНЫЙ ВЕТЕРИНАРНЫЙ УЛЬТРАЗВУКОВОЙ ЭХООСТЕОМЕТР ДЛЯ ОЦЕНКИ ФИЗИЧЕСКИХ ХАРАКТЕРИСТИК КОСТЕЙ СКЕЛЕТА ЖИВОТНЫХ ПРИ ИХ ФУНКЦИОНАЛЬНЫХ И ПАТОЛОГИЧЕСКИХ ИЗМЕНЕНИЯХ | trans-title = Portable Veterinary Ultravocation Echoosteometer For Assessment Of Physical Characteristics Of Animal Skeletal Bones With Functional And Pathological Changes | language = ru }}</ref>

===Types===
* Vitamin D-related rickets<ref name="AAFP">{{cite journal | vauthors = Nield LS, Mahajan P, Joshi A, Kamat D | title = Rickets: not a disease of the past | journal = American Family Physician | volume = 74 | issue = 4 | pages = 619–626 | date = August 2006 | pmid = 16939184 | url = http://www.aafp.org/afp/2006/0815/p619.html }}</ref>
** [[Vitamin D deficiency]]
** Vitamin D-dependent rickets (VDDR)<ref name=pmid32596195>{{cite journal | vauthors = Levine MA | title = Diagnosis and Management of Vitamin D Dependent Rickets | journal = Frontiers in Pediatrics | volume = 8 | pages = 315 | date = 2020 | pmid = 32596195 | pmc = 7303887 | doi = 10.3389/fped.2020.00315 | doi-access = free }}</ref>
*** Type 1: insufficiency in activation
**** VDDR1A: [[25-Hydroxyvitamin D3 1-alpha-hydroxylase]] deficiency
**** VDDR1B: [[CYP2R1]] deficiency
*** Type 2: resistance to calcitriol
**** VDDR2A: [[calcitriol receptor]] mutation
**** VDDR2B: unknown nuclear ribonucleoprotein interfering with signal transduction
*** Type 3: excessive inactivation ([[CYP3A4]] mutation, dominant)
* Hypocalcemia-related rickets
** [[Hypocalcemia]]
** [[Chronic kidney failure]] (CKD-BMD)
* Hypophosphatemia-related rickets
** Congenital
*** [[X-linked hypophosphatemia|Vitamin D-resistant rickets]]<ref name="AAFP"/>
*** [[Autosomal dominant hypophosphatemic rickets]] (ADHR)
*** Autosomal recessive hypophosphatemic rickets (ARHR)<ref name="PubMed">{{cite journal | vauthors = Levy-Litan V, Hershkovitz E, Avizov L, Leventhal N, Bercovich D, Chalifa-Caspi V, Manor E, Buriakovsky S, Hadad Y, Goding J, Parvari R | display-authors = 6 | title = Autosomal-recessive hypophosphatemic rickets is associated with an inactivation mutation in the ENPP1 gene | journal = American Journal of Human Genetics | volume = 86 | issue = 2 | pages = 273–278 | date = February 2010 | pmid = 20137772 | pmc = 2820183 | doi = 10.1016/j.ajhg.2010.01.010 }}</ref>
** [[Hypophosphatemia]] (typically secondary to malabsorption)
** [[Fanconi's syndrome]]
* Secondary to other diseases
** Tumor-induced osteomalacia
** [[McCune–Albright syndrome]]
** [[Epidermal nevus syndrome]]
** [[Dent's disease]]

===Differential diagnosis===
[[Osteochondrodysplasias]], also known as genetic bone diseases, may mimic the clinical picture of rickets in regard to the features of bone deformities.<ref name=elsobky2017>{{cite journal| vauthors = El-Sobky TA, Shawky RM, Sakr HM, Elsayed SM, Elsayed NS, Ragheb SG, Gamal R |title=A systematized approach to radiographic assessment of commonly seen genetic bone diseases in children: A pictorial review.|journal= J Musculoskelet Surg Res|volume=1|issue=2|pages=25|date=15 November 2017|doi=10.4103/jmsr.jmsr_28_17|s2cid=79825711 |doi-access= free}}</ref> The radiologic picture and the laboratory findings of serum calcium, phosphate and alkaline phosphatase are important differentiating factors. [[Blount's disease]] is an important differential diagnosis because it causes knee deformities in a similar fashion to rickets namely bow legs or [[genu varum]]. Infants with rickets can have bone fractures. This sometimes leads to child abuse allegations. This issue appears to be more common for solely nursing infants of black mothers, in winter in temperate climates, suffering poor nutrition and no vitamin D supplementation.<ref name="pmid18810424">{{cite journal | vauthors = Keller KA, Barnes PD | title = Rickets vs. abuse: a national and international epidemic | journal = Pediatric Radiology | volume = 38 | issue = 11 | pages = 1210–1216 | date = November 2008 | pmid = 18810424 | doi = 10.1007/s00247-008-1001-z | s2cid = 5848331 }}</ref> People with darker skin produce less vitamin D than those with lighter skin, for the same amount of sunlight.<ref>{{cite web | vauthors = Walker C | date = 8 July 2011 | work = Live Strong | title=CDark Skin Color & Vitamin D | url=http://www.livestrong.com/article/311881-dark-skin-color-vitamin-d/| access-date = 2 June 2012}}</ref>