The determination of rickets depends on presence of clinical findings as (enlarged wrists , frontal bossing, leg deformations, waddling walk, muscle weakness, and motor development delay) and radiological findings (e.g., widening, cupping and metaphyseal fraying) in addition to laboratory disturbance in Serum phosphate, (ionized) calcium, creatinine, bicarbonate, ALP, PTH, 25(OH)D, 1,25(OH)2D, plasma FGF23 (if available). The differential diagnosis of rickets can be nutritional rickets as in an infant with typical clinical symptoms and a history of low calcium intake and vitamin D prophylaxis suggests nutritional rickets—but it can be hereditay rickets as in a child with mild symptoms and decreased vitamin D levels, which is not uncommon.