Approach to Rickets: Is It Calciopenic or Phosphopenic?

Abseyi S. N., ŞIKLAR Z.

Turkish Archives of Pediatrics, vol.58, no.5, pp.458-466, 2023 (ESCI) identifier identifier

  • Publication Type: Article / Review
  • Volume: 58 Issue: 5
  • Publication Date: 2023
  • Doi Number: 10.5152/turkarchpediatr.2023.23050
  • Journal Name: Turkish Archives of Pediatrics
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.458-466
  • Keywords: Calcium metabolism, FGF2, Rickets, Vitamin D
  • Ankara University Affiliated: Yes


Rickets is a childhood disorder of decreased mineralization of bone tissue. It is either calcio-penic or phosphopenic, according to the deficient mineral. Calcium, phosphate, and vitamin D metabolism should be known to understand the pathophysiology of rickets. A deficiency of calcium or vitamin D can be caused by several conditions. These conditions lead to defective oste-oid mineralization, impaired chondrocyte differentiation, and apoptosis in the growth plate, resulting in clinical and radiological findings of rickets. Rickets developing as a result of vitamin D deficiency is the most frequently encountered form. Vitamin D-dependent rickets classification is made according to genetic abnormalities of enzymes that are involved in vitamin D metabolism. Phosphopenic rickets is divided mainly into 2 categories that are FGF23 related or not. A systemic approach that includes a detailed history, physical examination, and laboratory evaluation is required when performing a diagnostic evaluation. Vitamin D and calcium supple-mentation should be used to treat nutritional rickets. To prevent rickets and its morbidities, vitamin D prophylaxis in the newborn period is suggested. High dose of vitamin D3, 1.25(OH)2D, and calcium are treatment choices in vitamin D-dependent rickets according to its subgroup. If conventional treatment consisting of phosphate and calcitriol is ineffective in the treatment of phosphopenic rickets, Burosumab is the new treatment option.