Symptomatic rickets in adolescence

Abstract

Aim-To describe 21 cases of symptomatic rickets in adolescents. Methods-The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure. Results-Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diVuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day. Conclusion-Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case. (Arch Dis Child 2001;84:501-503)

Clinical Presentations of Vitamin D Deficiency in Children at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia: A Cross-Sectional Survey

“…Other previous studies in Saudi Arabia found that the most common complaint was back pain [1] and acute hypocalcemia manifestations [12]. The least common presentation of vitamin D deficiency was pathological fractures, according to research in another study [7].…”

Rickets in Healthy Adolescents in Van, the Eastern of Turkey

“…In our study, it was determined that none of the cases had a vitamin D supplementation and the cases had a diet included low amounts of vitamin D and calcium. Insufficient intake of calcium and vitamin D with nourishments and excessive consumption of carbonated drinks are determined to be risk factors for developing rickets in adolescents with symptomatic rickets (6). An 85% of cases in which a moderate and severe vitamin D insufficiency was determined had an intake of vitamin D less than 200 IU (20).…”

“…In a retrospective study performed by Narchi et al (6) in Saudi Arabia, symptomatic rickets' prevalence was found to be 68 per 100.000 children years. El-Hajj Fuleihan et al (13) was designed a study to investigate vitamin D insufficiency in healthy children.…”

“…Rickets was diagnosed on the basis of abnormal biochemical and/or radiological results (raised serum alkaline phosphatase, with or without raised Parathormone concentration, low serum 25(OH)D3 concentration (<20ng/ml) and presence of radiological findings in some cases (6). The children whose serum levels of vitamin 25(OH)D3 were below 10 ng/ml were accepted as vitamin D deficiency, but between 10 to 20 ng/ml were accepted as vitamin D insufficiency (10,11).…”

“…Nutritional rickets is still being a public health problem in the developing and undeveloped countries (2)(3)(4)(5). A type of rickets that knows as "adolescent rickets" which results from receiving inadequate of vitamin D (25(OH)D3) and insufficiently sun exposure and increased metabolic requirements secondary to rapid growing in pubertal period, could also be encountered (6,7). This type of rickets that is particularly seen in adolescent girls increase possibility of osteoporosis, osteomalacia and risk of developing bone fractures in the early life of adults (4).…”