Mastering 5 types of  rickets for MOCA And General Pediatric Boards 

Alright, pediatric residents, buckle up because we’re going to talk about rickets. We’re talking about the bone disease that makes your pediatric boards slightly more annoying than they already are. You see, rickets is like that sneaky plot twist in a movie—you know it’s coming, but you still need to understand why. After reading this you will also understand rickets symptoms, causes, and treatment .So let’s break down the different types of rickets like we’re dissecting a political scandal on The Daily Show.

1. Nutritional Rickets:

This is your basic, classic, “Oh look, we’re not getting enough vitamin D” type. “This is your classic, ‘Oops, the kid’s been living on kale and almond milk with zero sunlight,’ leading to soft bones and an awkward chat about nutrition with the parents.”. They’re either vitamin D, calcium, or phosphate deficient, which results in soft bones. On an X-ray, expect to see “cupping” and “fraying” at the metaphyses, especially in the wrist or knees—bones looking like they’ve been through a rough night in Vegas.

2. Vitamin D-Dependent Rickets (Type I):

This is like the Netflix reboot of nutritional rickets—same basic idea, but now it’s a genetic twist. The kid has vitamin D, but they can’t activate it properly because they’re missing 1 alpha hydroxylase Think of it like having a TV, but no remote control—you can’t change the channel, and all you’re stuck with is static (aka, rickets). These kids still have hypocalcemia and hypophosphatemia, but their 1,25-(OH)2 vitamin D levels are also as low. You give them calcitriol (active vitamin D 1,25 ), and it’s like magic—they’re cured.

3. Vitamin D-Dependent Rickets (Type II):

Oh, this one’s fun. It’s the “you can’t fire me, I quit” version of rickets. Here, the body has vitamin D and even activates it just fine, but then the cells are like, “Nah, we’re good. We’re not listening to you.” It’s resistance, like a teenager with their parents. These kids have elevated levels of 1,25-(OH)2 vitamin D because the body is trying hard to make it work, but the target tissues are just ignoring it. Treatment is a bit more complicated—you have to give them calcium supplements to help get the calcium levels up there

4. Hypophosphatemic Rickets:

This one’s about phosphate, the other MVP of bone formation. It’s like the plot where you think vitamin D is the bad guy, but nope, it’s a phosphate deficiency. Usually, it’s genetic, X-linked dominant (of course it is), and you’ve got a kid with normal calcium levels but low phosphate levels. These patients have normal vitamin D levels, but their bodies can’t handle phosphate properly. Treatment? You guessed it—phosphate supplements and calcitriol.

5. Renal Rickets (Renal Osteodystrophy):

Finally, we have the rickets that’s more than trying to assemble IKEA furniture with instructions written in ancient hieroglyphics—while blindfolded.” This one comes from chronic kidney disease (CKD). The kidneys stop working properly, which throws off calcium and phosphate levels and leads to—you guessed it—soft bones. These kids will have secondary hyperparathyroidism and may need a cocktail of phosphate binders, vitamin D, and a functioning kidney to really get things back on track.

Quick Cheat Sheet for Board Exams:

•Nutritional Rickets: Vitamin D deficiency, cupping, and fraying on X-ray. Treatment: Vitamin D and calcium.
•Vitamin D-Dependent Rickets Type I: Kid can’t activate vitamin D. Treatment: Calcitriol.
•Vitamin D-Dependent Rickets Type II: Body’s resistant to vitamin D. Treatment: Calcium supplements.
•Hypophosphatemic Rickets: It’s a phosphate problem, not vitamin D. Treatment: Phosphate and calcitriol.
•Renal Rickets: Chronic kidney disease messing up calcium and phosphate balance. Treatment: Phosphate binders, vitamin D.

Remember, rickets is like a bad political debate—it all comes down to the basics: nutrition, genetics, and bad chemistry! Keep these key points in your back pocket for the boards, and you’ll be flexing those pediatrician muscles in no time!