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Rickets guidance: part II-management.

Dieter Haffner1,2, Maren Leifheit-Nestler3,4, Andrea Grund3,4

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Area of Science:

  • Pediatrics
  • Endocrinology
  • Nephrology

Background:

  • Rickets management requires monitoring growth, bone deformities, pain, and key biochemical markers.
  • Diverse etiologies of rickets necessitate tailored therapeutic strategies.

Purpose of the Study:

  • To discuss current management of different rickets forms.
  • To highlight new therapeutic approaches based on recent guidelines.

Main Methods:

  • Monitoring of growth, leg bowing, bone pain, and serum levels of phosphate, calcium, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D3.
  • Assessment of calciuria and underlying pathophysiology for targeted treatment.

Main Results:

  • Calcipenic rickets require vitamin D supplementation or treatment based on pathophysiology.
  • Phosphopenic rickets management varies: FGF23-associated forms may use phosphate and vitamin D, tumor-induced osteomalacia requires tumor resection, and XLH benefits from burosumab.
  • Genetic defects and Fanconi syndrome-related rickets require specific treatments alongside phosphate and vitamin D.

Conclusions:

  • Optimal rickets management involves close monitoring and individualized treatment strategies.
  • New therapies, including burosumab, offer improved outcomes for specific rickets types.
  • Treatment adjustments are crucial to mitigate side effects like hypercalciuria and nephrocalcinosis.