Two types of nutritional rickets in infants

Lapatsanis, P; Makaronis, G.; Vretos, C; Doxiadis, S. A.

doi:10.1093/ajcn/29.11.1222

Cited by 14 publications

(7 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seventeen children were diagnosed as having vitamin D deficiency rickets of variable severity on the basis of accepted biochemical and radiographic criteria, and rapid healing following the introduction of ordinary therapeutic doses of vitamin D (6)(7)(8): Two infants (age 7.5 and 9 months) had persistent severe hypocalcemia and tetany (serum Ca 1.20 and 1.44 mmoUl, normal 2.39-2.79 mmolll), but normal P, high normal alkaline phosphatase (ALP) of 850 and 953 IU/I (normal <950 IUlI), and no definite radiographic evidence of rickets (stage I rickets (6, 7)). Three children (age 5-13 months) had stage I1 rickets (6, 7) based on radiographic signs of mild to moderate bone disease including both rarefaction and fraying of the provisional zone of calcification of the distal end of the radius and ulna.…”

Section: Methodsmentioning

confidence: 99%

Plasma Concentrations of Vitamin D Metabolites before and during Treatment of Vitamin D Deficiency Rickets in Children

Markestad

Halvorsen

et al. 1984

Acta Paediatrica

View full text Add to dashboard Cite

Plasma concentrations of 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), and 24,25-dihydroxyvitamin D (24,25-(OH)2D) were determined in 17 children with vitamin D deficiency rickets before therapy was started. Thirteen of them also had these tests repeated during treatment. The median 25-OHD concentration was at the lower limit of the reference range before, but increased distinctly within one week of treatment with 1 700-4 000 IU vitamin D per day (17 vs. 37 nmol/l, p less than 0.01). 24,25-(OH)2D was undetectable in twelve of the patients before therapy. Detectable concentrations were in the range of 1.7 to 3.5% of the corresponding 25-OHD levels throughout the study, and the two metabolites were closely correlated (r = 0.84, p less than 0.0005). The median 1,25-(OH)2D concentration was near the average of the reference range before, but increased to well above the upper limit of normal within one week of treatment (121 vs. 368 pmol/l, p less than 0.01). The levels were largely normal after 10 weeks of therapy, as were the plasma concentrations of calcium, phosphate, and alkaline phosphatase. Parathyroid activity, as judged by serum parathyroid hormone or urinary cyclic AMP concentrations, was stimulated in 11 of 12 children studied prior to treatment. It is concluded that there may be no clear-cut differences between normal nad rachitic values of the different vitamin D metabolites under practical clinical conditions. A low 25-OHD level combined with evidence of a stimulated parathyroid activity, and a rise of 1,25-(OH)2D levels to supernormal values following a few days of vitamin D therapy may be diagnostic clues.

show abstract

Section: Methodsmentioning

confidence: 99%

Plasma Concentrations of Vitamin D Metabolites before and during Treatment of Vitamin D Deficiency Rickets in Children

Markestad

Halvorsen

et al. 1984

Acta Paediatrica

View full text Add to dashboard Cite

show abstract

“…It is known that leaking of phosphate is responsible for the bone abnormalities in osteopenia and rickets ( 30,31). Whether the observed phosphate leaking in the children of the present study, would make them susceptible to bone loss, is not unequivocally clear.…”

Section: Discussionmentioning

confidence: 57%

Changes of mineral metabolism in juvenile chronic arthritis

et al. 1994

View full text Add to dashboard Cite

Thirty five children with ambulant JCA were studied to assess the biochemical parameters of bone metabolism. The mean age of the study group was 8.8±4.1 years and the mean duration of active disease 3.8±1.3 years. According to the onset of the disease the children belonged to the systemic (7), polyarticular (12) and pauciarticular type (16). All the patients were treated with NSAIDs. In addition the polyarticular group received either gold injections or D‐penicillamine and the systemic group, steroids for at least 3 months. Two groups of controls were studied. The first one included fifteen children without chronic arthritis or bone disease and the second, four children who were treated with corticosteroids for a variety of reasons. In the group with systemic JCA Se Pi (1.28±0.29 mmol/l) and renal phosphate reabsorption (TmP/GFR=1.07±0.18) were significantly lower than in the control groups (1.50±0.19; 1.54±0.25 mmol/l, p<0.01 and 1.35±0.18; 1.29+0.23 mmol/l GF, p<0.05). Also lower were serum alkaline phosphatase (58±16.4 versus 83±24.2 and 80±15.6 IU/l, p<0.05), osteocalcin (5.5±4.7 versus 11.0±4.5 and 10.0±5.7 ng/ml, p<0.05), 25OHD (15.6±4.9 versus 27.3±6.2 and20.6±9.8 ng/ml, p<0.001) and l,25(OH)2D (12.1±6.0 versus 20.9±11.0 and 27.6±3.2 pg/ml, p<0.05). In the other two groups of patients (polyarticular and pauciarticular) all the values were found to be in the normal range except for the concentration of 25OHD which was significantly lower (17.8±4.7 ng/ml, p<0.001) in the active group than in the patients in remission (27.0±7.1 ng/ml). Hypercalciuria (UCa/UCr>0.18 mg/mg and Ca excretion >4 mg/Kg/24h) was observed in 18% of JCA patients. In conclusion the children with systemic onset JCA seem to have a disturbance in bone and mineral metabolism. The activity of JCA appears to lead to lower levels of 250HD.

show abstract

“…Apart from this, nutritional rickets related to hypophosphatemia has been reported in an infant [15] and in a premature child with high levels of 1,25(OH)2D3 [16]. However, infants may be more susceptible than adults to phosphorus depletion rickets because of rapid bone growth [15]. On the other hand, in hypophosphatemia induced by chronic aluminum gel intoxication, phosphorus deficiency is not associated with any defect in vitamin D metabolism, but the rare cases of osteomalacia that have been reported were never confirmed by histomorphometric measurements [2,12].…”

Section: Discussionmentioning

confidence: 92%

“…In addition, in most cases of renal phosphate leak associated with osteomalacia the correction of bone mineralization defect by phosphorus therapy alone is controversial [13,14]. Apart from this, nutritional rickets related to hypophosphatemia has been reported in an infant [15] and in a premature child with high levels of 1,25(OH)2D3 [16]. However, infants may be more susceptible than adults to phosphorus depletion rickets because of rapid bone growth [15].…”

Section: Discussionmentioning

confidence: 99%

Nonosteomalacic osteopathy associated with chronic hypophosphatemia

et al. 1982

View full text Add to dashboard Cite

We studied bone histomorphometry in 19 patients with chronic hypophosphatemia related to an idiopathic renal phosphate wasting and without histological osteomalacia. Nine patients had renal lithiasis (group 1), three had radiological osteoporosis (group 2), and seven had lumbar pain (group 3). In the whole group of 19 patients, serum phosphate levels were low (24.9 +/- 2.1 mg/l), calcium in blood was normal, calcium in urine was increased, and iPTH was low. Histomorphometric data showed decreased osteoblastic surfaces with normal resorption surfaces, normal osteoid volume and calcification front. There was no correlation between serum phosphate level and histomorphometric parameters. There was no statistical difference between the data of the 3 groups of hypophosphatemic patients. We concluded that chronic hypophosphatemia in the adult doses not always lead to osteomalacia but to an unusual osteopathy characterized by an osteopenia due to an isolated decrease in bone formation. The respective importance of phosphate deficiency and of decreased iPTH level in the pathogenesis of this osteopathy is uncertain.

show abstract

Two types of nutritional rickets in infants

Cited by 14 publications

References 7 publications

Plasma Concentrations of Vitamin D Metabolites before and during Treatment of Vitamin D Deficiency Rickets in Children

Plasma Concentrations of Vitamin D Metabolites before and during Treatment of Vitamin D Deficiency Rickets in Children

Changes of mineral metabolism in juvenile chronic arthritis

Nonosteomalacic osteopathy associated with chronic hypophosphatemia

Contact Info

Product

Resources

About