Medical history (history of illness) represents an important component in the diagnosis of rickets or osteomalacia.
Family history
- What is the general health status of your relatives?
- Are there any diseases in your family that are common?
- Are there any hereditary diseases in your family?
Social anamnesis
Current medical history/systemic history (somatic and psychological complaints).
Child
- What symptoms have you noticed in your child?
- How long have these symptoms been present?
- Is your child restless? Does he sweat a lot? Does it suffer from constipation?
- Is your child thriving?
- Does any muscle weakness stand out?
- Does your child report bone pain?
- Have you noticed any changes in the child’s bones?
Adult
- What symptoms have you noticed?
- How long have these symptoms been present?
- Do you have any muscle weakness?
- Do you have bone pain?
- Have you noticed any changes in the child’s bones?
Vegetative anamnesis incl. nutritional anamnesis.
- Does your child have an adequate and balanced diet?
Self history including medication history.
- Pre-existing conditions (increased fracture propensity/bone fragility).
- Surgeries
- Radiotherapy
- Vaccination status
- Allergies
- Environmental history (lack of UV irradiation).
Medication history
- Vitamin D deficiency due to drug increased metabolism:
- Antiepileptic drugs
- Glutethmide (drug used as a sedative and hypnotic).
- Phenobarbital (drug used as an antiepileptic and hypnotic/sleep aid).
- Rifampicin (antibiotic from the group of tuberculostatics).
- Deficiency of 25-(OH)-vitamin D3, due to deficient 25-hydroxylase.
- Ioniazid (antibiotic from the group of tuberculostatics).
- Deficiency of 1,25-(OH)2-vitamin D3 due to decreased 1α-hydroxylation.
- Ketoconazole (oral antifungal/antifungal agent).
- Target organ resistance to vitamin D
- Phenytoin (antiepileptic drug)
- Hypophosphatemia (phosphate deficiency in the blood): phosphate-binding antacids, diuretics, and steroids.
- Drugs that affect vitamin D metabolism via the pregnane X receptor (→ increase expression of 24-hydroxylase, leading to increased degradation of vitamin D3 and calcitriol):
- Antiepileptic drugs: Carbamazepine, phenytoin,
- Antineoplastic drugs: cyclophosphamide, paclitaxel, tamoxifen.
- Antibiotics: Clotrimazole, rifampicin.
- Anti-inflammatory drugs: Dexamethasone
- Antihypertensive drugs: nifedipine, spironolactone.
- Antiretroviral drugs: ritonavir, saquinavir.
- Hormones: cyproterone acetate
- Phytotherapeutics Piper methysticum (Kawa-Kawa), St. John’s wort.
