Radiological and biochemical resolution of nutritional rickets with calcium * COMMENTARY

Abstract

Aims: To determine the response to oral calcium in Nigerian children with rickets. Methods: In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2-5 years) with confirmed rickets received calcium lactate (2.7 g/day). Results: Within one month of treatment leg pain was relieved and the children were more active. The mean x ray score improved from 3.3 at baseline to 1.7 at three months and 0.9 at six months (arbitrary scoring system, 0-6). Twelve cases were healed radiologically after six months, 11 others improved considerably, two showed no significant improvement, and a non-compliant patient was worse. There was progressive reversal of biochemical features. Median plasma alkaline phosphatase fell from 519 (range 178-1078) to 283 (209-443) IU/l (p = 0.04) in four months, while mean 1,25-dihydroxyvitamin D fell from 473 (251-1057) to 281 (155-481) pmol/l (p = 0.04), and mean plasma calcium increased from 2.26 (1.63-2.54) to 2.37 (2.06-2.54) mmol/l (p = 0.13). Parathyroid hormone fell from 5.3 (0.4-21.5) to 1.7 (0.45-7.4) pmol/l. Type I collagen carboxy terminal cross linked telopeptide was very high at baseline (20 (7.2-103) to 14 (11-24) µg/l) (p = 0.03) and fell promptly to normal. Conclusion: Calcium supplementation alone effected healing of rickets in most of these Nigerian children and may provide sufficient treatment in this environment.

Perception and knowledge of mothers on causes and treatment of rickets associated knee deformity in Ile-Ife, Osun State, Nigeria

“…Like in our study, tribe and religion were not found to be significant factors as children with rickets have been reported among all Nigerian tribes in among both Christians and Moslems (Oginni et al, 2003;Graff et al, 2004). Older respondents (>50 years old) were less aware of children with knee deformity as compared to women in the active childbearing age group.…”

“…A figure of 2.4% for overt rickets and 15% for suggestive rickets has been reported from Maiduguri, Nigeria (Akpede et al, 1999). In furtherance to the rickets as a major health problem, Oginni et al (2003) have reported a frequency of 1-2 active rickets per week presenting to the Wesley Guilds Hospital at the Ilesa Unit of the Obafemi Awolowo University Teaching Hospital Complex in Ile Ife, Nigeria.…”

“…Defective bone mineralization, bone pain, weakness and eventually pathological fracture may occur (Calmar & Vinci, 2002). Rickets presents most commonly between the ages of 6-36 months, which coincides, with the period of rapid growth and commencement of weight bearing (Oginni et al, 2003).…”

Increased bone alkaline phosphatase levels do not necessarily cause hypermineralization per se

“…This process is nicely illustrated in cases of childhood rickets and osteomalacia where poorly mineralized bone is associated with markedly elevated circulating BALP levels that decrease during bone healing [5,6]. Additional information on the mineralization state of bone in patients with type 2 diabetes mellitus has been provided by bone histomorphometric indices that demonstrate significantly reduced amount of mineralizing surface and lower bone formation rate in comparison with age-matched non-diabetic controls (Figure) [7].…”

Radiographic Changes in Nutritional Ricket Hips in Children in Response to Treatment

“…[1][2][3][4] Nutritional rickets has been widely studied in terms of aetiologies, 3,4 variants, [5][6][7] clinical presentations, 8,9 and drug treatments [10][11][12] and responses. 13,14 The growth plates of the proximal femur develop rapidly during infancy and childhood. 15 Traditional methods to study development of the proximal femur involve cadaveric dissection, 16 experiments in animals, 17 radiography, and magnetic resonance imaging.…”