Osteomalacia is the result of inadequately mineralized osteoid. Osteomalacia in children is called rickets, which is characterized by widening of the zone of provisional calcification and metaphyseal irregularity. Abnormalities related to rickets are most evident in areas of rapid growth. These include the costochondral junctions of the middle ribs, the distal femur, proximal humerus, both ends of the tibia, and the distal ulna and radius.

Etiologies of rickets:
a. Renal disease:
-renal osteodystrophy (most common cause)
-renal tubular disorders: vitamin D-resistent rickets
cystinosis and X-linked
hypophosphatemia.
b. Vitamin D deficiency: dietary lack (rare in U.S.), malabsorption.
c. Hepatocellular and biliary disease.
d. Anticonvulsant drug therapy: Dilantin, Phenobarbitol.
e. Tumor-associated rickets: associated neoplasms are in bone or
soft tissue. Most frequently hemangiopericytoma. Other lesions
include nonossifying fibroma, giant cell tumor, osteoblastoma.
Also includes nonneoplastic diseases such as neurofibromatosis
and fibrous dysplasia.

Radiographic findings:
- irregular widened physes
- poorly mineralized epiphyseal centers and delayed appearance
- cupping and fraying of metaphyses
- coarse trabeculation
- cortical spurs at right angles to metaphysis
- bowing of long bones
- may see periosteal reaction