Radiographic scoring method for the assessment of the severity of nutritional rickets

Thacher, Tom D.; Fischer, P.R.; Pettifor, John M.; Lawson, Juliana O.; Manaster, B.J.; Reading, James C.

doi:10.1093/tropej/46.3.132

Cited by 223 publications

(144 citation statements)

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“…Outcome assessments. The primary endpoint objective, evaluation of changes in the skeletal manifestations of hypophosphatasia (see Supplemental Methods), was obtained using the RGI-C (9) and RSS (20). The RGI-C, a 7-point ordinal scale, assesses hypophosphatasia skeletal disease in wrists and knees, including physeal widening, irregularity of the provisional zone of calcification, metaphyseal flaring, radiolucencies, and patchy osteosclerosis, as well as recent fractures (see Supplemental Methods) (9).…”

Section: Methodsmentioning

confidence: 99%

Asfotase alfa therapy for children with hypophosphatasia

Whyte¹,

Madson²,

Phillips³

et al. 2016

JCI Insight

136

113

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Section: Methodsmentioning

confidence: 99%

Asfotase alfa therapy for children with hypophosphatasia

Whyte¹,

Madson²,

Phillips³

et al. 2016

JCI Insight

136

113

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“…The methodology used does not support any determination of whether these associations may have been causal. Rickets in Chakaria appears to be of the Ca deficiency type that has been documented in South Africa (Pettifor et al, 1978) and Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a. It is significant that Chakaria is not regarded as among the poorest areas of Bangladesh, and that the level of malnutrition, including Ca undernutrition, among at-risk children in Chakaria is not substantially different from that of children living elsewhere in Bangladesh where rickets is not endemic.…”

Section: A Priori Hypothesesmentioning

confidence: 95%

“…It tends to be thought of in historic terms, without the recognition in many quarters that it continues to be a source of disability in the developing world. In recent years, rickets has been reported in some 21 countries (Bishop, 2001), including Tibet (Harris et al, 2001), Kuwait (Majid Molla et al, 2000), Ethiopia (Muhe et al, 1997), Yemen, (Banajeh et al, 1997), Mongolia (Fraser & Tserendolgor, 2001), the United Kingdom (Mughal et al, 1999), the United States (Eugster et al, 1996;Pugliese et al, 1998;Kreiter et al, 2000;Shah et al, 2000), South Africa (Pettifor et al, 1978), Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a, and Bangladesh (Snedecor & Cochran, 1967;Anonymous, 1998;Fischer et al, 1999;Staab et al, 1999;Karim et al, 2001). While some of these reports describe sporadic occurrences of the disease in association with lifestyle and the lack of solar exposure sufficient to support adequate vitamin D biosynthesis, studies in South Africa (Pettifor et al, 1978) and Nigeria (Okonofua et al, 1991;Oginni et al, 1996;Thacher et al, 1997Thacher et al, , 1999Thacher et al, , 2000a have shown the disease to be caused by primary dietary deficiencies of calcium (Ca).…”

Section: Introductionmentioning

confidence: 99%

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Combs

Hassan

2005

Eur J Clin Nutr

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Objective: A comprehensive, multiround survey of local food systems in a rickets-endemic area of Bangladesh was conducted to identify household-level risk factors for rickets. Design: A household-level, case-control study was conducted in a rickets-endemic area, Chakaria, with planned comparisons between households with one or more rachitic child and neighboring households with no affected children. Setting: A rickets-endemic area of southeastern Bangladesh, Chakaria. Subjects and methods: An interview-based survey was conducted in six villages in Chakaria with 199 households with at least one child showing physical signs consistent with rickets and 281 households with no affected children. Results: Households with rachitic children in Chakaria had more children, more pregnant or lactating women, and fewer adults than unaffected households in that community. Affected households tended to rely on farming for their livelihood and tended to have less economic activity as indicated by less outstanding debt than their neighbors. Households with rickets were at significantly greater risk of pneumonia than were other households. Calcium undernutrition was severe and widespread in Chakaria due to a food system that offered very little of the element in accessible forms. Household diets were based on cereals and starchy vegetables. Rice and fish constituted the major source of calcium for most households, although dairy products, when used, were very important calcium sources, particularly for young children. In fact, the use of dairy products was the only household choice that led to substantial increases in the calcium intakes of children, and households that used dairy products tended to show increased calcium intakes for all of their members. Conclusions: The risk of a Chakarian household having a child with rickets appeared to be related to its economic status. Although this might be expected to be manifest as limitations in food access and/or use, rickets households failed to show a dietary pattern associated with rickets. Calcium undernutrition was prevalent and, thus, would appear to be a predisposing factor for rickets; however, calcium undernutrition was prevalent in Chakarian households with and without rickets. Therefore, it is probable that another precipitating factor(s) play a role(s) in the etiology of rickets in Chakaria.

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“…Whilst this might be evident on radiographs, it is highly subjective [72], and there is little objective evidence to demonstrate mineralisation defects in children with clinical rickets. Three studies have measured bone mineralisation by DXA in children diagnosed with VDD rickets.…”

Section: Vitamin D and Bone Mineralisation Bone Mineral Density In Vimentioning

confidence: 99%

Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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Radiographic scoring method for the assessment of the severity of nutritional rickets

Cited by 223 publications

References 0 publications

Asfotase alfa therapy for children with hypophosphatasia

Asfotase alfa therapy for children with hypophosphatasia

The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh

Vitamin D and skeletal health in infancy and childhood

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