DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20182564

Subclinical rickets among children visiting a tertiary care hospital

Lakshmi Lakkappa, Roy Ninan Abraham, Chirsti D. Savio

Abstract


Background: Subclinical rickets is the early stage of rickets which can be defined as a state where there are no clinically appreciable changes of rickets but is characterized by biochemical changes which include the following Low or normal calcium, Low phosphorus, raised alkaline phosphatase and Low Vitamin D or raised Parathyroid hormone (PTH) levels. Radiological changes are often subtle to detect in sub clinical rickets. The objective of the present study was to estimate the prevalence of subclinical rickets in the age group 6 weeks to 15 years in tertiary care centre and to study their clinical profile.

Methods: Hospital based Cross sectional study was conducted among 156 children in the age group 6 weeks to 15 years over a period of 1 year at a tertiary care centre in South Bangalore. Evaluation and diagnosis of Subclinical rickets was done using various biochemical parameters such as Calcium, phosphorus and alkaline phosphatase and Wrist X ray.

Results: Overall Prevalence of Subclinical Rickets among the study group was 57 (36.5%). Sub clinical rickets was more common among Females (41.4%). Significant difference was observed in time spent for outdoor activities among children with (7.18±3.2 hrs) and without (9.04±4.4 hrs) subclinical rickets. Vitamin D supplemented group had lower prevalence of Subclinical rickets. 26% of them had Wrist Changes for sub clinical rickets. Significant decrease in Serum calcium and phosphorus was observed between subjects with and without subclinical rickets.

Conclusions: Prevalence of Subclinical Rickets in children aged between 6weeks to 15 years is significantly high. Optimal exposure to sunlight and Vitamin D supplementation can bridge the deficiency gap.


Keywords


Biochemical parameters, Children in tertiary care centre, Subclinical rickets, X ray wrist

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References


Majid-Molla A, Badawi MH, Al Yashi S, Sharma P, El Salaam RS, Molla AM. Risk factors for nutritional rickets among children in Kuwait. Pediatric Int. 2000;42(3):280-4.

Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398-417.

Pfitzner M, Thacher T, Pettifor J, Zoakah A, Lawsan T. Absence of Vitamin D deficiency in young Nigerian. J Pediatr. 1998;133(6):740-4.

Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of Vitamin D deficiency among healthy adolescents. Arch Pedaitr Adolesc Med. 2004;158(6):531-7.

Miller WL, Portale AA. Genetic disorders of vitamin D biosynthesis. Endocrinology and Metabolism Clinics. 1999;28(4):825-40.

Kruse K. Pathophysiology of calcium metabolism in children with Vitamin D - deficiency rickets. J Pediatr. 1995;126(5):736-41.

Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of Vitamin D deficiency. Arch Dis Child. 2004;89(8):781-4.

Shah TH, Hassan M, Siddiqui TS. Subclinical Nutritional Rickets Among Adolescents in Kaghan Valley. J Coll Physicians Surgeon Pakistan. 2014;24(9):663-5.

Abrams SA. Nutritional Rickets: an old disease returns. Nutr Rev. 2008; 60(4):111-3.

Hand book of Medical laboratory technology. 2nd edition by Robert H Carman, Christian Medical Association of India (publishers). Chapter 20: 357.

Editorial: Diagnosis of nutritional rickets. Lancet 1971;2:28-9.

Preece MA, Ford JA, McIntosh WB, Dunnigan MG, Tomlinson S, O'Riordan JIH. Vitamin D deficiency among Asian immigrants to Britain. Lancet. 1973;1:907-10.

Goel KM, Sweet EM, Logan RW, Warren JM, Arneil GC, Shanks RA. Florid and subclinical rickets among immigrant children in Glasgow. Lancet. 1976;1(7970):1141-5.

Shah TH, Hassan M, Siddiqui TS. Subclinical rickets. Pakistan J Med Sci. 2014;30(4):854-7.

Seo JY, Kim C, Lee HW, Ahn YM. Eight cases of incidentally diagnosed as subclinical rickets. Korean J Pediatr. 2008;51(8):812-9.

Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mole Bio. 2007;103(3-5):620-5.

Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D - deficiency rickets among children in Canada. Canadian Med Assoc J. 200717;177(2):161-6.

Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr. 2007;85(4):1062-7.

Wondale Y, Shiferaw F, Lulseged S. A systematic review of nutritional rickets in Ethiopia: status and prospects. Ethiopian Med J. 2005;43(3):203-10.

Balasubramanian S, Ganesh R. Vitamin D deficiency in exclusively breast-fed infants. Indian J Med Res. 2008;127(3):250.

Lee WT, Jiang J. The resurgence of the importance of vitamin D in bone health. Asia Pacific J Clin Nutr. 2008;17(S1):138-42.