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 Osteomalacia and Rickets Osteomalacia and Rickets
«Flowchart»
SUSPECTED RICKETS/OSTEOMALACIA CLINICAL/RADIOLOGICAL FEATURES
SUSPECTED RICKETS/OSTEOMALACIA CLINICAL/RADIOLOGICAL FEATURES
SUSPECTED RICKETS/OSTEOMALACIA CLINICAL/RADIOLOGICAL FEATURES
SUSPECTED RICKETS/OSTEOMALACIA CLINICAL/RADIOLOGICAL FEATURES

<Node Text>

<Node Text>

<Node Text>

<Node Text>

<Node Text>

<Go to node 3>

<Go to node 3>

<Go to node 3>

<Go to node 3> Node 3

<Go to node 4>

<Go to node 4>

<Go to node 4>

<Go to node 4> Node 4

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 4>

<End Node 4>

<End Node 4>

<End Node 4>

<End Node 4>
Ca, P, 25-D & PTH
Ca, P, 25-D & PTH
Ca, P, 25-D & PTH
Hypophosphatasia
Hypophosphatasia
Hypophosphatasia
Alkaline phosphatase
Alkaline phosphatase
Alkaline phosphatase

Low

Low

Low

Low

High

High

High

High

<Next Node>

<Next Node>

<Next Node>

<Next Node>

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

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

Transient increase in bone remodeling
consider various skeletal dysplasia
Transient increase in bone remodeling
consider various skeletal dysplasia
Transient increase in bone remodeling
consider various skeletal dysplasia

Calciopenic
Calciopenic
Calciopenic
Normal
Normal
Normal
Phosphopenic
Phosphopenic
Phosphopenic
VDD or
VDDR-1B
VDD or
VDDR-1B
VDD or
VDDR-1B

1,25-D
1,25-D
1,25-D
25-D-low
25-D-low
25-D-low
25-D-normal
25-D-normal
25-D-normal
VDDR-2 or HVO I
VDDR-2 or HVO I
VDDR-2 or HVO I
Calcium deficiency or recently VDD
Calcium deficiency or recently VDD
Calcium deficiency or recently VDD
lα-hydroxylase
deficiency
VDDR-1A
lα-hydroxylase
deficiency
VDDR-1A
lα-hydroxylase
deficiency
VDDR-1A


Low
Low
Low
N/high
N/high
N/high
High
High
High

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>

<Next Node>
TmP/GFR-low urine
AA/HCO3/Glu:High or
urine AA/HCO3/Glu high
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 norma
TmP/GFR-low
urine AA/HCO3/Glu: Normal or
urine AA/HCO3/Glu norma

3
3 TmP/GFR-low urine AA/HCO3/Glu: Normal or urine AA/HCO3/Glu norma
TmP/GFR-High
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
TmP/GFR & TRP urine AA/HCO3/glucose
TmP/GFR & TRP urine AA/HCO3/glucose
TmP/GFR & TRP urine AA/HCO3/glucose
3
Renal tubular defects
Renal tubular defects
Renal tubular defects
1,25-D & urine Ca
1,25-D & urine Ca
1,25-D & urine Ca
Nutritional phosphate depletion
Nutritional phosphate depletion
Nutritional phosphate depletion
TmP/GFR-low urine
AA/HCO3/Glu:High or
urine AA/HCO3/Glu high
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
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
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
Normal/high
Normal/high
Normal/high

End

End

End

End

End

End

End

End

FGF-23 mediated
XLH & TIO
FGF-23 mediated
XLH & TIO

FGF-23 mediated XLH & TIO
Non FGF-23 mediated HHRH
Non FGF-23 mediated HHRH
Non FGF-23 mediated HHRH