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Osteomalacia and Rickets

Jason B. Alisangco, DO, FAAFP and Patrick M. Carey, DO Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A metabolic bone disorder due to decreased bone mineralization (calcification) and increased organic bone matrix that results in decreased bone density

  • Referred to as renal osteodystr...

DIAGNOSIS

HISTORY

  • Signs and symptoms of hypocalcemia

    • Muscle cramps

    • Numbness

    • Paresthesias

    • Tetany

    • Seizures

    • Diarrhea

  • Common presentations in children (3)

    • Muscle weakness: may not be able to stand until age 3 ...

TREATMENT

MEDICATION

A combination of calcium and vitamin D is recommended (5)[A]. 

First Line

  • Calcium 1,000 mg/day PO

  • Children with vitamin D–deficiency rickets (6)[A]

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • For children, monitor the following:

    • Serum calcium, phosphorus, alkaline phosphatase, calcidiol

      • Serum phosphorus should increase during the 1st week of treatmen...

REFERENCES

1
Pettifor JM. Nutritional rickets: pathogenesis and prevention. Pediatr Endocrinol Rev.  2013;10(Suppl 2):347–353. [View Abstract on OvidMedline]
2
Holick MF. Vitamin D deficiency. N Eng...

ADDITIONAL READING

  • American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 495: vitamin D: screening and supplementation during pregnancy. Obste...

CODES

ICD10

  • M83.9 Adult osteomalacia, unspecified

  • E55.0 Rickets, active

  • N25.0 Renal osteodystrophy

  • M83.1 Senile osteomalacia

  • M83.5 Other drug-induced osteomalacia in adults

  • M83.4 Aluminum bone disease

  • M83.3 ...

CLINICAL PEARLS

  • In the United States, rickets occurs almost exclusively in breastfed infants without vitamin D supplementation or sun exposure.

  • Children and adolescents with increased skin pigmentation...

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