Etiology and treatment of calcipenic rickets in children
- Thomas Carpenter, MD
Thomas Carpenter, MD
- Professor of Pediatrics (Endocrinology)
- Professor of Orthopaedics and Rehabilitation Yale University School of Medicine
- Section Editors
- Marc K Drezner, MD
Marc K Drezner, MD
- Section Editor — Bone Disease
- Professor of Medicine
- University of Wisconsin Medical School
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
Calcipenic rickets comprises a group of disorders in which supply of calcium or its intestinal absorption is too low to match the calcium demands imposed by bone growth.
The most common cause of calcipenic rickets is dietary deficiency of vitamin D and/or calcium, which leads to insufficient intestinal absorption of calcium. Alternatively, calcipenic rickets may be caused by decreased vitamin D activity (eg, lack of conversion to the active metabolite or resistance to the active metabolite). Patients with calcipenic rickets have secondary hyperparathyroidism and characteristic changes of the growth plates and metaphyseal bone.
The clinical features of rickets and diagnostic evaluation to determine the cause of rickets are discussed in a separate topic review. (See "Overview of rickets in children".)
In brief, patients with calcipenic rickets are identified by elevated parathyroid hormone (PTH) and normal or low serum inorganic phosphorus (algorithm 1). Serum calcium levels are usually low in calcipenic rickets, but may be normal in some stages of the disease due to a compensatory increase in PTH. Measurement of serum 25-hydroxyvitamin D (25OHD) helps to categorize the disorder into one of the following subcategories, which are discussed in detail in this topic review (algorithm 2):
●Dietary vitamin D deficiency (the "classical" form of rickets)
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- NUTRITIONAL RICKETS
- Vitamin D deficiency
- - Etiology
- - Prevention
- - Clinical course
- - Treatment
- - Monitoring
- Calcium deficiency
- - Etiology
- - Treatment
- VITAMIN D "DEPENDENT" RICKETS
- 1-alpha-hydroxylase deficiency
- - Etiology
- - Treatment
- - Monitoring
- 25-hydroxylase deficiency
- Hereditary resistance to vitamin D
- - Etiology
- - Clinical features
- - Treatment
- - Monitoring
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS