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Contributor Details
Name
*
Institute/Hospital
*
Email
*
Email OTP
*
Mobile
*
Patient Details
Name
*
Age
*
Gender
*
--Select--
Male
Female
Others
Education
Address
State
Contact Number 1
Contact Number 2
Email:
Aadhar number:
Presenting Complaints
Bone deformity of Upper Limb
--Select--
Yes
No
Bone deformity of Lower Limb
--Select--
Yes
No
Presenting Complaints
*
Premature loss of Tooth
Rickets
Osteomalacia
Arthritis / Joint pain
Recurrent Fractures
Muscle weakness
seizures
Age at presentation / Symptomatic since in years
Birth History
Consanguinity
--Select--
Yes
No
Previous Death in utero in family
--Select--
Yes
No
Clinical Examination
Height at presentation in cm
Weight in kg
Lower Incisor loss
--Select--
Yes
No
Upper Incisor loss
--Select--
Yes
No
Beading of costo-chondral junction
--Select--
Yes
No
Wrist widening
--Select--
Yes
No
Pectus Excavatum
--Select--
Yes
No
Bowed Leg / Knock knee
--Select--
Yes
No
Waddling gait
--Select--
Yes
No
Genu Varum
--Select--
Yes
No
Deafness
--Select--
Yes
No
Biochemical Investigations
Urea in mg/dl
Creatinine (mg/dl)
Ca (mg/dl)
*
Phosphate (mg/dl)
*
PTH (pg/ml)
*
25 hydroxy vitamin D (ng/ml)
*
FGF 23 level (RU/ml or PG/ml)
Bone specific Alkaline Phosphatase
P1NP
CTX
24 hours urinary ca
*
24 hours urinary po4
24 hours urinary creatinine
*
Skeletal Survey
Looser’s Zone /Pseudo fracture site
*
--Select--
Nil
Skull Lateral
Left Forearm
Right Forearm
Right Femur
Left Femur
Left Femur
Right Knee
Left Knee
Tongues of Radio lucency
*
--Select--
Nil
Skull Lateral
Left Forearm
Right Forearm
Right Femur
Left Femur
Left Femur
Right Knee
Left Knee
Copper beaten apperance
*
--Select--
Nil
Skull Lateral
Left Forearm
Right Forearm
Right Femur
Left Femur
Left Femur
Right Knee
Left Knee
Skeletal Image(Jpeg/PDF)
Skeletal Image(Jpeg/PDF)
Skeletal Image(Jpeg/PDF)
Skeletal Image(Jpeg/PDF)
Genetic Report
Attach Genetic Report (Jpeg/PDF)
Audiogram
Right ear
Left ear
Complications
Infantile Hypophosphatesia
--Select--
yes
no
Poor feeding
--Select--
yes
no
Failure to thrive
--Select--
yes
no
Delayed motor mile stones
--Select--
yes
no
Papilledema
--Select--
yes
no
Intracerebral haemorrhages
--Select--
yes
no
hypercalcemia and hyperphosphatemia
--Select--
yes
no
Nephrocalcinosis
--Select--
yes
no
Renal damage
--Select--
yes
no
Synostosis
--Select--
yes
no
