Osteomalacia and rickets


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Osteomalacia and rickets


Pediatric musculoskeletal conditions

Radial head subluxation (Nursemaid elbow)

Developmental dysplasia of the hip

Legg-Calve-Perthes disease

Slipped capital femoral epiphysis

Transient synovitis

Osgood-Schlatter disease (traction apophysitis)

Musculoskeletal injuries and trauma

Rotator cuff tear

Dislocated shoulder

Radial head subluxation (Nursemaid elbow)

Winged scapula

Thoracic outlet syndrome

Carpal tunnel syndrome

Ulnar claw

Erb-Duchenne palsy

Klumpke paralysis

Iliotibial band syndrome

Unhappy triad

Anterior cruciate ligament injury

Patellar tendon rupture

Meniscus tear

Patellofemoral pain syndrome

Sprained ankle

Achilles tendon rupture



Degenerative disc disease

Spinal disc herniation


Compartment syndrome


Bone disorders

Osteogenesis imperfecta


Pectus excavatum


Genu valgum

Genu varum

Pigeon toe

Flat feet

Club foot

Cleidocranial dysplasia



Bone tumors




Osteomalacia and rickets


Paget disease of bone


Lordosis, kyphosis, and scoliosis

Joint disorders



Spinal stenosis

Rheumatoid arthritis

Juvenile idiopathic arthritis


Calcium pyrophosphate deposition disease (pseudogout)

Psoriatic arthritis

Ankylosing spondylitis

Reactive arthritis


Septic arthritis


Baker cyst

Muscular disorders

Muscular dystrophy



Inclusion body myopathy

Polymyalgia rheumatica



Neuromuscular junction disorders

Myasthenia gravis

Lambert-Eaton myasthenic syndrome

Other autoimmune disorders

Sjogren syndrome

Systemic lupus erythematosus

Mixed connective tissue disease

Antiphospholipid syndrome

Raynaud phenomenon


Limited systemic sclerosis (CREST syndrome)

Musculoskeletal system pathology review

Back pain: Pathology review

Rheumatoid arthritis and osteoarthritis: Pathology review

Seronegative and septic arthritis: Pathology review

Gout and pseudogout: Pathology review

Systemic lupus erythematosus (SLE): Pathology review

Scleroderma: Pathology review

Sjogren syndrome: Pathology review

Bone disorders: Pathology review

Bone tumors: Pathology review

Myalgias and myositis: Pathology review

Neuromuscular junction disorders: Pathology review

Muscular dystrophies and mitochondrial myopathies: Pathology review

Pediatric musculoskeletal disorders: Pathology review


Osteomalacia and rickets


0 / 19 complete

USMLE® Step 1 questions

0 / 4 complete

High Yield Notes

16 pages


Osteomalacia and rickets

of complete


USMLE® Step 1 style questions USMLE

of complete

A 9-year-old boy is brought to the pediatrician by his parents because of bone pain and an abnormal gait pattern. The patient and his family recently immigrated to the United States from India. Prior to immigrating, the patient’s diet consisted mostly of rice and salted vegetables due to food shortages. Vitals are within normal limits. He is below the 10th percentile for height and weight. Radiographic imaging reveals the following findings:  

Image reproduced from Radiopedia  

Which of the following set of laboratory findings will be most likely present in this patient?  

External References

First Aid









in osteomalacia/rickets p. 473

Hypophosphatemic rickets p. 57

Osteomalacia/rickets p. 473

Parathyroid hormone (PTH) p. 336

osteomalacia/rickets p. 473

Rachitic rosary p. 473

Rickets p. 473

Fanconi syndrome p. 719

hypophosphatemic p. 617, 617

inheritance p. 57

lab values in p. 474

vitamin D deficiency p. 68

Vitamin D deficiency p. 350

osteomalacia/rickets p. 473, 473


Content Reviewers


Jake Ryan

Salma Ladhani, MD

Pauline Rowsome, BSc (Hons)

Bone softening caused by a faulty process of bone mineralization manifests as either rickets in children or osteomalacia in adults.

Inadequate bone mineralization could be due to a deficient or impaired metabolism of vitamin D, phosphate or calcium.

But first, a bit about bones. Now, long bones, like the femur, are made up of two epiphyses, which are its ends, and the diaphysis, which is the shaft.

Between each epiphysis and the diaphysis, there’s a region called the metaphysis.

And the metaphysis contains the epiphyseal plate, or the growth plate, which is the part of the bone that grows during childhood.

Once growth stops, the growth plate is replaced by an epiphyseal line, and this is known as epiphyseal closure.

Now, for bones to grow and develop properly, special bone cells, called osteoblasts, are hard at work.

To build bone, osteoblasts secrete osteoid, which is an organic matrix made of type 1 collagen.

These collagen fibers are the framework for the osteoblasts' work.

Osteoblasts then deposit calcium and phosphate crystals into the framework.

This process is called bone mineralization, and it confers strength to the growing bones.

Bone mineralization is dependent on an enzyme called alkaline phosphatase - which increases in response to osteoblast activity.

So, at the end of the day, bones are like a storage warehouse for calcium and phosphate.

Now, the levels of calcium and phosphate in the bone, but also in the blood, are regulated by vitamin D and parathyroid hormone, or PTH.

Vitamin D-wise, two steps are necessary for optimal metabolism: first, there must be enough vitamin D in the body, either from food, or created in the skin in response to sunlight exposure.


Rickets and osteomalacia are conditions characterized by bone softening due to a calcium deficiency or lack of vitamin D. The main difference between the two is the age at which they occur. Osteomalacia affects adults, whereas rickets affects children.

The key symptoms are diffuse bone and joint pain, proximal muscle weakness, bone fragility, and increased risk of fractures with minimal trauma. For rickets, there may also be craniotabes( softening and thinning of skull bones). The treatment typically involves vitamin D supplementation and treating the underlying cause.


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  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
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  6. "Triradiate deformity of the pelvis in Paget's disease of bone." Postgraduate Medical Journal (1980)
  7. "Vitamin D supplementation in pregnancy: a systematic review" Health Technology Assessment (2014)

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