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Nutritional and metabolic rickets.

M Teotia1, S P Teotia

  • 1Post-graduate Department of Human Metabolism and Endocrinology, L.L.R.M. Medical College, Meerut, U.P.

Indian Journal of Pediatrics
|March 1, 1997
PubMed
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Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: year 2000.

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Metabolic studies in congenital vitamin D deficiency rickets.

Indian journal of pediatrics·1995

Nutritional rickets, a vitamin D deficiency disorder, affects children lacking sunlight exposure. Diagnosis involves low 25-hydroxyvitamin D and high parathyroid hormone levels, with treatment often requiring high-dose vitamin D for Indian children.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Nutritional Science

Background:

  • Nutritional rickets is primarily caused by vitamin D deficiency, often linked to insufficient sunlight exposure.
  • Neonatal rickets is a specific form occurring in infants whose mothers have severe osteomalacia.
  • Calcium deficiency alone leads to osteoporosis and secondary hyperparathyroidism, not primary mineralization defects.

Purpose of the Study:

  • To outline the causes and diagnostic markers of nutritional rickets.
  • To discuss the specific case of neonatal rickets.
  • To highlight diagnostic criteria and treatment considerations for rickets, particularly in Indian children.

Main Methods:

  • Analysis of biochemical markers including plasma 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (IPTH), alkaline phosphatase, calcium, and urinary hydroxyproline.

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  • Radiological and histomorphometric assessment of bone disease.
  • Review of nutritional factors, including vitamin D and fluoride intake.

    • Main Results:

    • Diagnostic indicators for rickets include low 25-OHD, elevated IPTH, increased alkaline phosphatase, decreased plasma calcium, and increased urinary hydroxyproline.
    • During vitamin D treatment, low 25-OHD may coexist with high 1,25(OH)2D and IPTH.
    • Marginal fluoride intake (> 2.5 mg/day) can induce rickets in calcium-deficient children.

    Conclusions:

    • Rickets diagnosis relies on a combination of clinical and biochemical findings.
    • Indian children frequently require high-dose vitamin D therapy due to severe vitamin D depletion and bone disease.
    • Understanding these factors is crucial for effective rickets management and prevention.