Patient selection: pediatric patient prior to closure of the growth plates
Clinical findings:
(1) stunted growth for age
(2) genu varum (bowlegs) beyond 2 years of age or genu valgum (knock knees)
(3) abnormal gait
(4) tenderness on bone palpation
(5) hyperreflexia
(6) rachitic rosary due to beading along the costochondral junctions
(7) indentation of ribs at the level of the diaphragm (Harrison's groove)
(8) dental abnormalities with enamel defects and caries
(9) frequent fractures or fracture after minor injury
(10) kyphosis ("cat back"), lordosis and/or scoliosis
(11) frontal bossing of the skull
(12) weight gain faster than growth in height resulting in an enlarged abdomen (rachitic potbelly)
(13) apathetic, listless, easily fatigued and hypokinetic
(14) diffuse bone pain
Imaging findings:
(1) osteopenia with thinning of cortices and fuzzy trabeculae
(2) flaring of wrists, ankles and other joints
(3) widening of physis (growth plate)
(4) fraying and cupping of the metaphysis
(5) craniotabes (reduced mineralization of the skull), particularly over the parietal and occipital bone, with prominence of the suture lines ("hot-cross-bun" skull)
(6) delayed closure of the anterior fontanelle
(7) microfractures
(8) pseudo-fractures (Looser's zones)
Laboratory findings:
(1) increased serum alkaline phosphatase for age
(2) normal or low serum calcium
(3) normal or low serum phosphate
