“Rachitomalacia” – Radiological Findings of a “New” Intermediate Entity in Adolescents
Original Article | Volume 11 | Issue 2 | May-August 2025 | Page: 11-15 | Anil Agarwal, Sitanshu Barik, Eknoor Kaur
DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.230
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted: 21/06/2025; Reviewed: 02/07/2025; Accepted: 23/07/2025; Published: 10/08/2025
Authors: Anil Agarwal MS Ortho [1], Sitanshu Barik MS Ortho [2], Eknoor Kaur MS Ortho [3]
[1] Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
[2] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India.
[3] Department of Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Address of Correspondence
Dr. Anil Agarwal,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
E-mail: anilrachna@gmail.com
Abstract
Background: This study proposes an intermediate radiological entity in adolescents with calcium/vitamin D deficiency, exhibiting features of both rickets and osteomalacia but lacking classical signs of either. We have used the term “Rachitomalacia” to describe this unique radiographic presentation. The report describes the atypical radiological findings of rachitomalacia in adolescents and highlights its distinction from classical rickets and osteomalacia. The study will aid in the early diagnosis and appropriate management of this previously unrecognized clinical and radiographic entity.
Material and Methods: A retrospective analysis of 10 adolescents (8 females, 2 males; mean age 11.1±0.6 years) presenting to a tertiary pediatric hospital (2020–2021) with knee deformities or pain. Inclusion criteria: (1) radiographs showing metaphyseal lucency with vertical striations or widened physis without cupping/splaying; (2) biochemical evidence of vitamin D deficiency (25(OH)D <20 ng/mL) and/or elevated alkaline phosphatase; (3) exclusion of non-nutritional metabolic disorders (e.g., hypophosphatemic rickets). Biochemical and radiographic assessments were performed, followed by calcium/vitamin D therapy.
Results: All patients demonstrated hypovitaminosis D (18.9±4.8 ng/mL) and elevated alkaline phosphatase (1196.7±689.9 IU/L), with normal serum calcium/phosphorus. Radiographs revealed: (1) loss of metaphyseal architecture with vertical striations, (2) widened physis with osteopenia, and (3) incomplete metaphyseal fractures. Treatment normalized biochemical/radiological parameters.
Conclusion: Rachitomalacia presents with subtle, atypical radiographic features in adolescents, distinct from classical rickets or osteomalacia. Recognizing these signs—particularly metaphyseal striations and physeal widening—is critical to prompt diagnosis and treatment, preventing deformities during rapid pubertal growth. Clinicians should consider rachitomalacia in adolescents with nonspecific musculoskeletal complaints and suboptimal vitamin D levels.
Keywords: Rickets, Osteomalacia, Adolescent, Radiograph
References
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| How to Cite this Article: Agarwal A, Barik A, Kaur E. “Rachitomalacia” – Radiological findings of a “New” Intermediate Entity in Adolescents. International Journal of Paediatric Orthopaedics. May-August 2025; 11(2): 11-15. |
