Rickets

All patients require careful monitoring of serum calcium, phosphorus, calcidiol, and alkaline phosphatase levels. Monitoring of the urine can detect changes in calcium and phosphorus levels, and in the urinary calcium-to-creatinine ratio, which indicates hypercalciuria. Abnormal fluctuations in serum or urine values may require adjustment to the dose of medication. Within a week after initiation of treatment, biochemical changes (a rise in the levels of phosphorus and calcium) and radiographic changes may be evident, and physical examination findings revert to normal within 6 months.[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26. https://www.aafp.org/afp/2006/0815/p619.html http://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com

Less common types of rickets will likely need subspecialty consultation to assist with ongoing management.[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26. https://www.aafp.org/afp/2006/0815/p619.html http://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com

Additional monitoring

Patients with vitamin D resistance require monitoring of 1,25-dihydroxyvitamin D, parathyroid hormone (PTH), and the urinary calcium-to-creatinine ratio evaluated at least every week initially.

Patients with hypophosphatemic rickets require monitoring of PTH levels and monitoring for nephrocalcinosis.

Disease resolution

After resolution of active medical disease, surgical therapy may be considered if deformities are severe.