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Fractures

Low 25-hydroxyvitamin D Elevated alkaline phosphatase Elevated osteocalcina

®This finding has not been consistently reported.

®This finding has not been consistently reported.

the skeleton is that both rickets and osteomalacia have unmineralized bone matrix (osteoid), also known as widened osteoid seams.

In rare cases, e.g., in central Nigeria, rickets may occur despite elevated serum 25(OH)D3 concentrations. The rickets in these cases results from severely inadequate dietary calcium. It is likely that most cases of rickets result from a combination of insufficient skin biosynthesis and inadequate dietary intake of vitamin D.

Other biochemical changes include depressed serum concentrations of calcium and inorganic phosphate, largely because of insufficient intestinal absorption directly relating to too little of these ions in the usual diet. Serum alkaline phosphatase, especially bone-specific alkaline phosphatase, is elevated because of osteoblastic cell overproduction when these cells attempt to form new bone tissue.

Radiographic changes, the primary diagnostic evidence for many years, show widened growth plates of the long bones and reduced bone density (translu-cence) in rickets. In osteomalacia, unmineralization is evident and pseudofractures may be visible in nonweight-bearing bones.

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