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The re-emerging burden of rickets: a decade of experience from Sydney
P D Robinson1, W Högler, M E Craig
1The Children's Hospital at Westmead, Sydney, Australia. paulr3@chw.edu.au
Insights
Nutritional rickets cases are increasing in Australia, predominantly affecting immigrant children. Public health policies should implement screening for at-risk families to address this growing concern.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Nutritional rickets, a condition caused by vitamin D deficiency, remains a concern even in developed nations.
- Recent trends indicate a rise in rickets cases, necessitating a closer examination of demographics and clinical presentations.
Purpose of the Study:
- To define the demographics and clinical characteristics of children presenting with nutritional rickets at Sydney pediatric centers.
- To identify trends and risk factors associated with nutritional rickets in a developed country.
Main Methods:
- A retrospective descriptive study was conducted on 126 cases diagnosed with vitamin D deficiency and/or rickets between 1993 and 2003.
- Diagnosis was confirmed by long bone X-ray changes.
Main Results:
- A significant increase in cases was observed, with a doubling from 2002 to 2003.
- The median age of presentation was 15.1 months; common features included hypocalcemic seizures (33%) and bowed legs (22%).
- The majority of affected children were recent immigrants or their offspring, primarily from the Indian subcontinent, Africa, and the Middle East, with 79% born in Australia.
Conclusions:
- Despite high sunlight exposure, a substantial and increasing caseload of vitamin D deficiency rickets persists in Australia.
- Rickets cases reflect immigration patterns, and birth or residence in Australia does not confer protection.
- Screening of at-risk immigrant families through public health policies is recommended to mitigate this public health issue.
Aim:
To define the demographics and clinical characteristics of cases presenting with nutritional rickets to paediatric centres in Sydney, Australia.
Methods:
Retrospective descriptive study of 126 cases seen from 1993 to 2003 with a diagnosis of vitamin D deficiency and/or confirmed rickets defined by long bone x ray changes.
Results:
A steady increase was seen in the number of cases per year, with a doubling of cases from 2002 to 2003. Median age of presentation was 15.1 months, with 25% presenting at less than 6 months of age. The most common presenting features were hypocalcaemic seizures (33%) and bowed legs (22%). Males presented at a younger age, with a lower weight SDS, and more often with seizures. The caseload was almost exclusively from recently immigrated children or first generation offspring of immigrant parents, with the region of origin predominantly the Indian subcontinent (37%), Africa (33%), and the Middle East (11%). Seventy nine per cent of the cases were born in Australia. Eleven cases (all aged <7 months) presented atypically with hyperphosphataemia.
Conclusions:
This large case series shows that a significant and increasing caseload of vitamin D deficiency remains, even in a developed country with high sunlight hours. Cases mirror recent immigration trends. Since birth or residence in Australia does not appear to be protective, screening of at risk immigrant families should be implemented through public health policies.
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