Etiology of rickets

Deficient intake of minerals

Inadequate calcium intake

Inadequate phosphate intake

Poor absorption of minerals

Vitamin D deficiency

25-hydroxylase deficiency

1-alpha-hydroxylase deficiency (previously called vitamin D-dependent rickets type I or pseudovitamin D deficiency)

Hereditary resistance to vitamin D (previously called vitamin D-dependent rickets type II)

High phytin content (eg, soy formula)

Antacids

Antiseizure medications (eg, phenytoin, phenobarbital)

Kidney function impairment

Fanconi syndrome

Hepatic insufficiency

Fat malabsorption (eg, cystic fibrosis)

Increased excretion of minerals

Furosemide

Renal tubular dysfunction

Phosphaturia (eg, X-linked hypophosphatemic rickets, hereditary hypophosphatemic rickets with hypercalcuria, tumor-induced osteomalacia)
Renal tubular acidosis with hypercalciuria
Renal tubular damage (eg, cystinosis, tyrosinosis, galactosemia, fructose intolerance, Wilson disease, lead poisoning, other heavy metal poisoning)

Tumors

Local defect of bone cells

Hypophosphatasia (alkaline phosphatase deficiency)

Adapted from: Bergstrom WH. Twenty ways to get rickets in the 1990's. Contemp Pediatr 1991; 8:88.

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