Rickets is a metabolic abnormality in which a deficiency of Vitamin D leads to failure of normal bone mineralization. This disease is manifested earliest at the sites of rapid growth, namely the knees and wrists. Common causes of rickets include: 1) nutritional (dietary insufficiency), 2) malabsorption, 3) renal disease, or 4) increased requirement for vitamin D.

Radiographic findings:

• demineralization with coarsening of the trabecular pattern
• widening of the physis
• metaphyseal fraying, cupping and irregularity at the physeal margin
• deformity (i.e. bowing)
• flared anterior ribs

Patients may be susceptible to slipped capital femoral epiphyses as well as pathologic fractures.

Rickets in a 2-year-old female. AP radiograph of the knees demonstrates widened growth plates and frayed metaphyses. Also note the bowing of the long bones (tibia and fibula bilaterally).