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Disorders of bone metabolism in severely handicapped children and young adults
J J Lee1, E D Lyne, M Kleerekoper
1Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, MI 48202.
Insights
Severely handicapped children often have vitamin D deficiency, impacting bone health. Direct measurement of vitamin D metabolites is crucial for diagnosis and effective treatment.
Area of Science:
- Pediatrics
- Endocrinology
- Nutritional Science
Background:
- High prevalence of vitamin D deficiency in severely handicapped children.
- Growth deficiencies may mask typical signs of vitamin D deficiency.
- Anticonvulsant use complicates the presentation and diagnosis of vitamin D deficiency.
Purpose of the Study:
- To highlight the challenges in diagnosing vitamin D deficiency in this population.
- To emphasize the importance of direct vitamin D metabolite measurement.
- To discuss effective treatment strategies.
Main Methods:
- Review of clinical presentations and diagnostic challenges.
- Analysis of biochemical markers for vitamin D deficiency.
- Evaluation of treatment responses.
Main Results:
- Standard indicators like calcium, phosphate, and alkaline phosphatase are unreliable.
- Direct measurement of vitamin D metabolites is essential for accurate diagnosis.
- Patients show positive responses to nutritional support and increased sunlight exposure.
Conclusions:
- Vitamin D deficiency is common and requires specific diagnostic approaches in handicapped children.
- Treatment involving nutritional support and sunlight is effective.
- Nutritional status significantly influences metabolic bone disease and stature.
Abstract:
There is a high prevalence of vitamin D deficiency in the severely handicapped pediatric population. Because many of these patients have growth deficiencies, they may not demonstrate wide growth plates commonly seen with vitamin D deficiency. There is also a high prevalence of anticonvulsant use in these patients, and its exact impact is not clear because of the variety of its effects and presentations. Calcium, phosphate, and alkaline phosphatase are not useful as indicators of vitamin D deficiency, and vitamin D metabolites must be measured directly. Patients with low vitamin D levels respond to treatment, including nutritional support and added sunlight exposure. The overall nutritional status of this population may be reflected in their metabolic bone disease and small stature.