Diagnostic approach to rickets: an Endocrine Society of Bengal (ESB) consensus statement
- Author:
Ajitesh ROY
1
;
Amarta Shankar CHOWDHURY
;
Arindam RAY
;
Arjun BAIDYA
;
Bibek ROYCHOWDHURY
;
Dasarathi SARKAR
;
Debmalya SANYAL
;
Indira MAISNAM
;
Kaushik BISWAS
;
Kaushik PANDIT
;
Mainak BANERJEE
;
Moutusi RAYCHAUDHURI
;
Nilanjan SENGUPTA
;
Partha Pratim CHAKRABORTY
;
Pradip MUKHOPADHYAY
;
Pradip RAYCHAUDHURI
;
Pranab Kumar SAHANA
;
Rajan PALUI
;
Rana BHATTACHARJEE
;
Sarmistha MUKHOPADHYAY
;
Satinath MUKHOPADHYAY
;
Sayantan RAY
;
Soumik GOSWAMI
;
Subhankar CHOWDHURY
;
Subhodip PRAMANIK
;
Subir Chandra SWAR
;
Sujoy GHOSH
;
Sunetra MONDAL
;
Tapas Chandra DAS
Author Information
- Publication Type:Review Article
- From:Annals of Pediatric Endocrinology & Metabolism 2024;29(5):284-307
- CountryRepublic of Korea
- Language:English
- Abstract: Rickets, one of the leading causes of bony deformities and short stature, can be calciopenic (inciting event is defective intestinal calcium absorption) or phosphopenic (inciting event is phosphaturia). Early diagnosis and timely treatment of rickets are crucial for correction of the limb deformities. Guidelines exist for nutritional rickets, but the diagnosis and management of the relatively uncommon forms of rickets are complex. This consensus aims to formulate a simplified diagnostic approach for rickets, especially in resource-limited settings. The consensus statement has been formulated by a 29-member committee from the Endocrine Society of Bengal. The process included forming a working group, conducting a literature review, identifying controversies, drafting, and discussion at a consensus meeting. Participants rated their agreement with the clinical practice points, and a 70% consensus was required. Input integration and further review led to the final consensus statements. Children with suspected rickets should initially be examined for distinctive skeletal deformities. The diagnosis of rickets should be confirmed with characteristic radiographic abnormalities. It is advisable to order tests for serum calcium, inorganic phosphorus (Pi), liver function, 25-hydroxyvitamin D (25OHD), parathyroid hormone, creatinine, and potassium in all patients with rickets. In cases of refractory rickets, it is also recommended that assessments be conducted for spot urine calcium, Pi, creatinine, and, blood gas analysis. In children with rickets and metabolic acidosis, tests for glycosuria, uricosuria, aminoaciduria, low molecular weight proteinuria, and albuminuria should be conducted. In children with resistant calciopenic rickets and sufficient serum 25OHD levels, serum 1,25(OH)2D concentration should be tested. 1,25(OH)2 D and fibroblast growth factor 23 estimation is useful for certain forms of phosphopenic rickets.
