Radiographic dilemma of four systemic bone diseases: rickets, osteomalacia, renal osteodystrophy, and hypophosphatemic rickets (literature review)
Abstract
Objectives: Rickets, osteomalacia, renal osteodystrophy, and hypophosphatemic rickets are systemic diseases that have the same characteristics, namely the condition of bone softening or weak bone conditions. This condition is caused by low levels of calcium and phosphorus in the bones. As a result, the bones become of poor quality, which can be seen histologically in the form of a picture of bone osteoid that is less calcified. However, the etiology of the causes of abnormalities in these four diseases is different, and in particular, the picture in the radiograph certainly has its own character.Review: The purpose of writing this article is to learn more about the special characteristics of these four systemic diseases. The writing method used is a narrative literature review. This article will discuss the four types of systemic diseases, starting from the definition, clinical appearance, appearance in radiographs, and the characteristics of each type. The results of the characterization that has been carried out indicate that, in general, radiography and other imaging methods are indeed difficult to distinguish because they have the same symptoms, but at the beginning of the case, the picture can be distinguished.
Conclusion: The conclusion that can be drawn from this article is that between rickets, osteomalacia, renal osteodystrophy, and hypophosphatemic rickets, there are specific characteristics that are the main key in recognizing each abnormality, especially radiographically, that can be recognized.
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3. Gjørup H, Kjaer I, Sonnesen L, Beck-Nielsen SS, Haubek D. Morphological characteristics of frontal sinus and nasal bone focusing on bone resorption and apposition in hypophosphatemic rickets. Orthod Craniofac Res. 2013;16(4):246–55.
4. Cianferotti L. Osteomalacia is not a single disease. Int J Mol Sci. 2022;23(24):15910.
5. Abdul S, Ibraheem R. Dental manifestation of generalized enamel hypoplasia and the calcium role due to environmental vitamin D deficiency in rickets and osteomalacia patients. Med J Babylon. 2013;10(4):902–9.
6. You M, Tang B, Wang Z, Wang K, Wang H. Radiological manifestations of renal osteodystrophy in the orofacial region: a case report and literature review. Oral Radiol. 2018;34(3):262–6.
7. Modest JM, Sheth H, Gohh R, Aaron RK. Osteomalacia and renal osteodystrophy. R I Med J (2013). 2022;105(8):22–27.
8. Raubenheimer EJ, Noffke CE, Mohamed A. Expansive jaw lesions in chronic kidney disease: review of the literature and a report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(3):340–5.
9. Souza MA, Soares LAV, Santos MA, Vaisbich MH. Dental abnormalities and oral health in patients with hypophosphatemic rickets. Clinics. 2010;65(10):1023–6.
10. Haffner D, Emma F, Eastwood DM, Duplan MB, Bacchetta J, Schnabel D, et al. Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia. Nat Rev Nephrol. 2019;15(7):435–55.
11. Bandgar T, Shah N. Revisiting hypophosphatemic rickets/osteomalacia. Best Pract Res Clin Endocrinol Metab. 2024;38:101744.
12. Ismunandar H, Himayani R, al Farisi M. Rakhitis: tinjauan pustaka. Medula. 2020;10(2):150–6.
13. Minisola S, Colangelo L, Pepe J, Diacinti D, Cipriani C, Rao SD. Osteomalacia and vitamin D status: a clinical update 2020. JBMR Plus. 2021;5(1):e10447.
14. Massahud BC, Henriques JCG, Jacobs R, Rosa RR, Matai CVB. Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices. Oral Radiol. 2018;34(2):172–8.
15. Çakur B, Sümbüllü MA, Dağistan S, Durna D. The importance of cone beam CT in the radiological detection of osteomalacia. Dentomaxillofac Radiol. 2012;41(1):84–8.
16. Riyachan I, Subarnbhesaj A, Sarideechaigul W, Klanrit P. Oral manifestations of renal osteodystrophy in a patient with systemic lupus erythematosus with chronic renal failure and secondary hyperparathyroidism: a case report. J Dent Indones. 2019;26(3):165–9. doi:10.14693/jdi.v26i3.1003
17. Lopes MLD, Albuquerque AFM, Germano AR, Queiroz LMG, Miguel MCC, da Silveira EJD. Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease. Oral Maxillofac Surg. 2015;19(3):321–7
18. Chaussain-Miller C, Sinding C, Wolikow M, Lasfargues JJ, Godeau G, Garabédian M. Dental abnormalities in patients with familial hypophosphatemic vitamin D-resistant rickets: prevention by early treatment with 1-hydroxyvitamin D. J Pediatr. 2003;142(3):324–31
19. Ponto J, Farkas D, Segal JD, Yusupov Y. Maxillomandibular osteotomy healing in a patient with hypophosphatemic rickets. Int J Oral Maxillofac Surg. 2021;50(12):1591–5.
20. Funck-Brentano T, Vanjak A, Ostertag A, Nethander M, Fernandez S, Collet C, et al. Evaluation of bone density and microarchitecture in adult patients with X-linked hypophosphatemic rickets: a pilot longitudinal study. Bone. 2024;187:116452.
21. Murayama T, Iwatsubo R, Akiyama S, Amano A, Morisaki I. Familial hypophosphatemic vitamin D-resistant rickets: dental findings and histologic study of teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(3):310–6.
22. Opsahl Vital S, Gaucher C, Bardet C, Rowe PS, George A, Linglart A, et al. Tooth dentin defects reflect genetic disorders affecting bone mineralization. Bone. 2012;50(4):989–97.
23. Ribeiro TR, Costa FWG, Soares ECS, Williams JR, Fonteles CSR. Enamel and dentin mineralization in familial hypophosphatemic rickets: a micro-CT study. Dentomaxillofac Radiol. 2015;44(5):20150054.
Published
2025-12-31
How to Cite
RAHASDINI, Puri; EPSILAWATI, Lusi.
Radiographic dilemma of four systemic bone diseases: rickets, osteomalacia, renal osteodystrophy, and hypophosphatemic rickets (literature review).
Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI), [S.l.], v. 9, n. 3, p. 202-209, dec. 2025.
ISSN 2686-1321.
Available at: <http://jurnal.pdgi.or.id/index.php/jrdi/article/view/1364>. Date accessed: 29 jan. 2026.
doi: https://doi.org/10.32793/jrdi.v9i3.1364.
Section
Review Article
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
