<prompt> All of the following are seen in rickets except:September 2009Frenkels lineWidening of epiphysis- diaphysis distanceCupping and splaying of metaphysisRarefaction  <response>: Ans. A: Frenkels LineIn rickets, the skeletal effects are due to lack of calcification of osteoid.The first changes of rickets appear in rapidly growing distal ends of ulna radius wrist knee are commonly involved due to more use.Rarefaction of provisional zone of calcification with widening of epiphysis- diaphysis distance is first to appear. The most obvious change are at metaphysis- where rapid growth is occurring.First change to appear is a loss of normal zone of provisional calcification adjacent to metaphysis.This begins as an indistinctness of the metaphyseal margin, progressing to a frayed appearance with widening of the growth plate, due to lack of calcification of metaphyseal bone.Weight bearing stress on uncalcified bone gives rise to splaying Sr cupping of metaphysis.A similar but less marked effect occurs in subperiosteal layer, which may cause lack of distinctness of coical margin.Eventually a generalized reduction in bone density is seen.In the epiphysis - there may be some haziness of coical margin.Thus all findings in Rickets occur due to failure of calcification abnormal demineralizationi. Skull changes- Pronounced calvarial demineralization- Basilar Invagination- Indistinct sutural margin- Delayed tooth eruption Premature craniostenosis- Craniotabes- Calvarial thickening following treatmentii. Spine changes- Scoliosis- Biconcave veebral bodies- Triradiatic pelvis. 