Purpose or Case Report: Learning Objectives:
-To recognize age-specific radiographic manifestations of rickets and understand how imaging features evolve from infancy through adolescence.
-To distinguish between nutritional, genetic, and systemic causes of rickets using characteristic imaging patterns.
-To identify common mimics of rickets and differentiate them from true metabolic bone disease.
-To understand the complementary roles of radiography and MRI in challenging cases.

Background: Rickets is a pediatric metabolic bone disorder characterized by imaging features that change according to the patient's age and underlying cause. Some conditions may mimic rickets due to similar radiologic features; therefore, accurate recognition of hallmark radiographic signs—including metaphyseal fraying, cupping, widening, and angular deformities—is critical for timely diagnosis, appropriate management, and differentiation from mimics. Nutritional rickets remains the most prevalent cause, particularly among exclusively breastfed infants without adequate vitamin D supplementation. However, older children with rickets frequently have genetic and systemic causes, such as renal and phosphate metabolism disorders. Although radiographs remain the principal imaging modality for evaluation, MRI may provide enhanced diagnostic precision in challenging or unclear cases. Clinical red flags warranting imaging evaluation include persistent or worsening bowing beyond expected physiologic ages, motor delays, pathologic fractures, failure to thrive, and lack of response to vitamin D supplementation in older children, which suggests genetic or renal etiologies rather than simple nutritional deficiency.

This educational poster presents an age-based approach to diagnosing rickets, illustrating classic radiographic features across different age groups and etiologies. Key imaging findings in nutritional rickets, hypophosphatemic rickets, and renal osteodystrophy are systematically compared. Common mimics—including scurvy, non-accidental trauma, Blount's disease, osteogenesis imperfecta, and physiologic variants—are reviewed with comparative imaging to enhance diagnostic accuracy. Emphasis is placed on pattern recognition, and the role of advanced imaging in equivocal cases.
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