Suggested Clinical Algorithm Based on Biochemical Abnormalities in Evaluating Patients Suspected of Having Rickets, Osteomalacia, or Both

Suggested Clinical Algorithm Based on Biochemical Abnormalities in Evaluating Patients Suspected of Having Rickets, Osteomalacia, or Both - Flowchart Osteomalacia and Rickets Osteomalacia and Rickets

«Flowchart»

SUSPECTED RICKETS/OSTEOMALACIA
CLINICAL/RADIOLOGICAL FEATURES

Hypophosphatasia

Alkaline phosphatase

Low

High

End

VDD or VDDR-1B

25-D-low

25-D-normal

l-hydroxylase deficiency VDDR-1A

Calcium deficiency or recently VDD

VDDR-2 or HVO I

1,25-D

Low

N/high

High

Ca, P, 25-D & PTH

Calciopenic

PTH high
P-normal; Ca-low/normal
25-D-normal/low

Calciopenic

PTH high
P-normal; Ca-low/normal
25-D-normal/low

PTH high

PTH high

Normal

Transient increase in bone remodeling consider various skeletal dysplasia

Normal

Transient increase in bone remodeling consider various skeletal dysplasia

Normal

Phosphopenic

Hypophosphatemia (<2.5 mg/dl)
Normal: Ca, PTH & 25-D

Phosphopenic

Hypophosphatemia (<2.5 mg/dl)
Normal: Ca, PTH & 25-D

Hypophosphatemia

Renal tubular defects

Nutritional phosphate depletion

1,25-D & urine Ca

Normal/high

FGF-23 mediated XLH & TIO

Non FGF-23 mediated HHRH

TmP/GFR & TRP urine AA/HCO₃/glucose

₃

TmP/GFR-low urine AA/HCO₃/Glu: High or urine AA/HCO₃/Glu high

₃ ₃ TmP/GFR-low urine AA/HCO3/Glu: High or urine AA/HCO3/Glu high

TmP/GFR-low urine AA/HCO₃/Glu: Normal or urine AA/HCO₃/Glu normal

₃ ₃ TmP/GFR-low urine AA/HCO3/Glu: Normal or urine AA/HCO3/Glu normal

TmP/GFR-High urine AA/HCO₃/Glu: Normal or urine AA/HCO₃/Glu normal

₃ ₃ TmP/GFR-High urine AA/HCO3/Glu: Normal or urine AA/HCO3/Glu normal