Assessment of nutritional rickets in Western Saudi Arabia

To explore the role of radiological examination and certain biochemical values in diagnosis and assessing severity of nutritional rickets.

Cases of symptomatic nutritional rickets (age range between 3-36 months) seen at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, during the period 1997-1999 were studied. Clinical examination by the author of the study, determination of calcium (Ca), phosphate (PO4), alkaline phosphates (ALP), hand and wrist x-rays, were performed for all cases.

Sixty cases of nutritional rickets were diagnosed within 2 years (incidence of 0.5%), 38.3% of the patients presented with swollen wrist and 28.3% with bowleg. The bone profile at time of diagnosis: Ca=2.33 +/- 0.23, PO4 = 1.47 +/- 0.40 and ALP = 925 +/- 418. Approximately 81.7% of the patients had normal Ca level, 18.3% had low serum PO4 level, 98.3% showed high value of ALP. X-ray studies indicated that, 58.3% of patients had active rickets, 35% had minimal changes, and 6.7% showed healed rickets. Among those having active rickets 20% had low PO4 level, 83% had normal Ca value, and 100% had high ALP. The mean value +/- SD of biochemical values in this group: Ca = 2.34 +/- 0.24, PO4 = 1.45 +/- 0.42, ALP = 1067 +/- 452. The later was significantly higher compared to other groups (P=0.004) but no significant differences were observed between mean values of other parameters.

Radiological examination and ALP remains essential to confirm clinical diagnosis of rickets and assessment of severity.