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Biochemical manifestations of different stages of vitamin D deficiency, as compared with deficiencies of calcium or phosphorus

Biochemical manifestations of different stages of vitamin D deficiency, as compared with deficiencies of calcium or phosphorus
  Plasma Ca++ Plasma PO4 ALP PTH 25OHD 1,25(OH)2D Radiograph changes
Vitamin D deficiency
Early N or ↓ N or ↓ ↑ ↑ ↓ N Reduced bone mineralization
Moderate N or ↓ ↓ ↑↑ ↑↑ ↓↓ ↑ Rachitic changes +
Severe ↓↓ ↓↓ ↑↑↑ ↑↑↑ ↓↓↓ ↑ or N or ↓ Rachitic changes ++
Calcium deficiency with normal vitamin D status
  N or ↓ ↓ ↑↑ ↑↑ N ↑ or N or ↓ (depending on the cause) Variable extent of rachitic changes
Phosphorus deficiency (due to renal phosphate wasting)
  N or ↑ ↓↓ ↑

Usually N or slightly ↑ (if mediated by excess FGF23)

Low-normal (if not mediated by excess FGF23 or nutritional)		 N

N or ↓ (if mediated by excess FGF23)

↑↑ (if not mediated by excess FGF23)		 Variable extent of rachitic changes
ALP: alkaline phosphatase; PTH: parathyroid hormone; 25OHD: 25-hydroxyvitamin D; 1,25(OH)2D: 1,25-dihydroxyvitamin D; N: normal; FGF23: fibroblast growth factor 23.
Data from: Levine MA, Zapalowski C, Kappy MS. Disorders of calcium, phosphate, parathyroid hormone, and Vitamin D. In: Kappy MS, Allen DB, and Geffner ME (Eds). Principles and Practice of Pediatric Endocrinology. Charles C. Thomas Co, Springfield, 2005.
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