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Radiological and biochemical resolution of nutritional rickets with calcium
L M Oginni1, C A Sharp, O S Badru
1Department of Orthopaedic Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
Insights
Oral calcium supplementation effectively treated rickets in Nigerian children. Most patients showed radiological healing and biochemical improvement, indicating calcium alone can be sufficient treatment.
Area of Science:
- Pediatrics
- Nutritional Science
- Biochemistry
Background:
- Rickets is a significant skeletal disorder in children, particularly prevalent in regions with limited sunlight exposure and dietary calcium intake.
- Understanding the efficacy of simple supplementation is crucial for public health interventions in affected populations.
Purpose of the Study:
- To evaluate the therapeutic response to oral calcium supplementation in Nigerian children diagnosed with rickets.
- To assess both clinical and biochemical markers of healing following calcium treatment.
Main Methods:
- A cohort of 26 Nigerian children (aged 2-5 years) with confirmed rickets received daily oral calcium lactate (2.7 g).
- Clinical improvement was monitored through symptom relief and activity levels.
- Radiological scoring and biochemical parameters (alkaline phosphatase, 1,25-dihydroxyvitamin D, calcium, parathyroid hormone, and collagen cross-linked telopeptide) were assessed over six months.
Main Results:
- Significant improvement in radiological scores from a mean of 3.3 to 0.9 over six months, with 12 cases achieving radiological healing.
- Marked reduction in plasma alkaline phosphatase and 1,25-dihydroxyvitamin D levels, alongside a decrease in parathyroid hormone.
- Clinical benefits included relief of leg pain and increased activity within one month of treatment.
Conclusions:
- Oral calcium supplementation alone demonstrated significant efficacy in healing rickets in the majority of Nigerian children studied.
- Calcium therapy may represent a sufficient and accessible treatment strategy for rickets in this specific geographical and nutritional context.
Aims:
To determine the response to oral calcium in Nigerian children with rickets.
Methods:
In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2-5 years) with confirmed rickets received calcium lactate (2.7 g/day).
Results:
Within one month of treatment leg pain was relieved and the children were more active. The mean x ray score improved from 3.3 at baseline to 1.7 at three months and 0.9 at six months (arbitrary scoring system, 0-6). Twelve cases were healed radiologically after six months, 11 others improved considerably, two showed no significant improvement, and a non-compliant patient was worse. There was progressive reversal of biochemical features. Median plasma alkaline phosphatase fell from 519 (range 178-1078) to 283 (209-443) IU/l (p = 0.04) in four months, while mean 1,25-dihydroxyvitamin D fell from 473 (251-1057) to 281 (155-481) pmol/l (p = 0.04), and mean plasma calcium increased from 2.26 (1.63-2.54) to 2.37 (2.06-2.54) mmol/l (p = 0.13). Parathyroid hormone fell from 5.3 (0.4-21.5) to 1.7 (0.45-7.4) pmol/l. Type I collagen carboxy terminal cross linked telopeptide was very high at baseline (20 (7.2-103) to 14 (11-24) micro g/l) (p = 0.03) and fell promptly to normal.
Conclusion:
Calcium supplementation alone effected healing of rickets in most of these Nigerian children and may provide sufficient treatment in this environment.