Variable Presentations of Rickets in Children in the Emergency Department

Bloom, Erete; Klein, Eileen J.; Shushan, Denise; Feldman, Kenneth W.

doi:10.1097/01.pec.0000113889.10140.7a

Cited by 26 publications

(18 citation statements)

References 17 publications

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“…In a national survey in Canada, 11 of 108 cases of NR (11%) had suffered fractures, although details on the bone sites and numbers of fractures were not provided [1] . Fractures also have been reported in cases or case series of NR in toddlers and adolescents [45][46][47][48][49][50] , but details about the number, site, and type of fracture were absent.…”

Section: 2 Evidencementioning

confidence: 99%

“…There is abundant, yet low-quality evidence from multiple case reports, case series [11,48,49,88] , and observational studies [1,2,45,50,85,[89][90][91][92][93][94][95][96][97][98][99] that exclusive breast-feeding without vitamin D supplementation is a major risk factor for NR in infants. Furthermore, prolonged breast-feeding with late introduction of complementary feeding is associated with NR in infants not receiving vitamin D supplements [26,[100][101][102][103][104][105] .…”

Section: Evidencementioning

confidence: 99%

See 1 more Smart Citation

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

363

477

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Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. nology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

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Section: 2 Evidencementioning

confidence: 99%

Section: Evidencementioning

confidence: 99%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

363

477

View full text Add to dashboard Cite

show abstract

“…There are few reports regarding the sites of fracture in children with rickets, but in case reports a variety of sites were involved, including clavicle, radius/ulna, lateral rib and femur [55][56][57][58][59][60]. Only one study has retrospectively evaluated fracture patterns in children with rickets.…”

Section: Fracture In Children With Vitamin D Deficiency Ricketsmentioning

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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“…In fact, many studies suggest that fracture risk in children may be a function of lower bone mineralization associated with genetic [29] and environmental factors, such as poor nutrition and physical inactivity [30][31][32][33][34]. The relationship between low vitamin D levels and fracture risk has been extensively studied above all in infants with rickets [35][36][37][38][39][40] and for osteoporotic fractures in adults [41][42][43][44], but its significance in children and adolescents has been investigated to a lesser extent. A few studies have documented vitamin D deficiency to be a common problem among otherwise healthy adolescents and correlated this deficiency with decreased bone density in youth [11,15,45].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of vitamin D insufficiency in Swiss teenagers with appendicular fractures: A prospective study of 100 cases

Ceroni

Llana

Martin

et al. 2012

Journal of Children's Orthopaedics

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Background The significance of subclinical vitamin D deficiency in the pathogenesis of fractures in children and adolescents currently remains unclear.Objective We aimed to determine the prevalence of vitamin D insufficiency and its effect on bone mineral density (BMD) and bone mineral content (BMC) values in a collective of Swiss Caucasian children with a first episode of appendicular fracture. Design and methods One hundred teenagers with a first episode of appendicular fracture [50 upper limb fractures (group 1) and 50 lower limb fractures (group 2)] and 50 healthy controls (group 3) were recruited into a crosssectional study. The BMC and BMD values were measured by dual-energy X-ray absorptiometry, and serum 25 hydroxyvitamin D [25(OH)D] was assessed by electrochemiluminescence immunoassays.Results From the 100 injured teenagers in the study, 12 % had deficient vitamin D levels (\20 ng/mL; \50 nmol/L) and 36 % had insufficient levels (C20 \30 ng/mL; C50 \78 nmol/L), whereas 6 and 34 % of healthy controls were, respectively, vitamin D deficient and insufficient. There were no significant differences for serum 25(OH)D levels, L2-L4 BMD Z-score, and L2-L4 BMC Z-score variables (p = 0.216) between the three groups nor for the calcaneal BMD Z-score variables (p = 0.278) between healthy controls and lower limb fracture victims. Investigations on the influences of serum 25(OH)D on BMD and BMC showed no correlation between serum 25(OH)D and L2-L4 BMD Z-scores (r = -0.15; p = 0.135), whereas low but significant inverse correlations were, surprisingly, detected between serum 25(OH)D and calcaneal BMD Z-scores (r = -0.21; p = 0.034) and between serum 25(OH)D and L2-L4 BMC Z-scores (r = -0.22; p = 0.029). Conclusions A significant proportion of Swiss Caucasian teenagers were vitamin D insufficient, independent of limb fracture status, in our study. However, this study failed to show an influence of low vitamin D status on BMD and/or BMC of the lumbar spine and heel.

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Variable Presentations of Rickets in Children in the Emergency Department

Cited by 26 publications

References 17 publications

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Vitamin D and skeletal health in infancy and childhood

Prevalence of vitamin D insufficiency in Swiss teenagers with appendicular fractures: A prospective study of 100 cases

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