Biochemical manifestations of different stages of vitamin D deficiency, as compared with deficiencies of calcium or phosphorus

	Plasma Ca⁺⁺	Plasma PO₄	ALP	PTH	25OHD	1,25(OH)₂D	Radiograph changes
Vitamin D deficiency
Early	N or ↓	N or ↓	↑	↑	↓	N	Reduced bone mineralization
Moderate	N or ↓	↓	↑↑	↑↑	↓↓	↑	Rachitic changes +
Severe	↓↓	↓↓	↑↑↑	↑↑↑	↓↓↓	↑ or N or ↓	Rachitic changes ++
Calcium deficiency with normal vitamin D status
	N or ↓	↓	↑↑	↑↑	N	↑ or N or ↓ (depending on the cause)	Variable extent of rachitic changes
Phosphorus deficiency (due to renal phosphate wasting)
	N or ↑	↓↓	↑	Usually N or slightly ↑ (if mediated by excess FGF23) Low-normal (if not mediated by excess FGF23 or nutritional)	N	N or ↓ (if mediated by excess FGF23) ↑↑ (if not mediated by excess FGF23)	Variable extent of rachitic changes

ALP: alkaline phosphatase; PTH: parathyroid hormone; 25OHD: 25-hydroxyvitamin D; 1,25(OH)₂D: 1,25-dihydroxyvitamin D; N: normal; FGF23: fibroblast growth factor 23.

Data from: Levine MA, Zapalowski C, Kappy MS. Disorders of calcium, phosphate, parathyroid hormone, and Vitamin D. In: Kappy MS, Allen DB, and Geffner ME (Eds). Principles and Practice of Pediatric Endocrinology. Charles C. Thomas Co, Springfield, 2005.

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Biochemical manifestations of different stages of vitamin D deficiency, as compared with deficiencies of calcium or phosphorus