• Metaphyseal cupping and fraying
• Widened epiphyses
• Osteopenia
• Bowing deformities

Bulbous enlargement of the anterior costochondral junctions forming a rachitic rosary. There is also generalized osteopenia and metaphyseal splaying of the proximal humeri.

DDX Tibial Bowing

• Blount’s disease
• Neurofabromatosis (anterior, pseudoarthroses)
• Thanantophoric Dwarfism (telephone receivers)
• Skeletal Dysplasia (FD, OI)
• Vitamin deficiency or resistance to Vit D (hypophosphatemia)
• Congenital Pseudoarthroses of the tibia

DDX Frayed Metaphyses CHARMS

• Congenital infection (Rubella, Syphillis)
• Hypophosphatemia (Vit D resistance Rickets)
• Achondroplasia
• Rickets
• Metaphyseal Dysostosis
• Scurvy