Differential diagnosis of pediatric metabolic bone disease

• Scurvy
• Copper deficiency
• Vitamin D deficiency rickets
• Hereditary hypophosphatemic rickets
• Primary hyperparathyroidism
• Secondary hyperparathyroidism
• Pseudohypoparathyroidism
• Hypervitaminosis A
• Lead poisoning
• Prostaglandin osteopathy

Approach to the differential diagnosis of metabolic bone disease:

• The most common finding in all types of rickets is widening of the physis and cupping / fraying of the metaphysis
• In lead poisoning, look for dense metaphyseal bands as well as radiopaque lead fragments in the bowel
• Prostaglandin osteopathy should be surveilled for in ductal dependent patients on Prostaglandin E