Symptomatic rickets in adolescence.
OBJECTIVE
To describe 21 cases of symptomatic rickets in adolescents.


METHODS
The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure.


RESULTS
Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diffuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day.


CONCLUSIONS
Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case.
Narchi
H
H
Al-Hasa Specialty Services Division, Saudi Aramco-Al-Hasa Health Center, Box 6030, Mubarraz 31311, Saudi Arabia. hassibnarchi@hotmail.com
El Jamil
M
M
Kulaylat
N
N
D015652:25-Hydroxyvitamin D 2 / Q000097:blood; D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D002136:Calcium, Dietary / Q000008:administration & dosage; D002648:Child; D015930:Diet Records; D005260:Female; D006128:Growth; D006801:Humans; D006996:Hypocalcemia / Q000150:complications; D008297:Male; D018673:Nutrition Policy; D010146:Pain / Q000209:etiology; D010758:Phosphorus / Q000097:blood; D012279:Rickets / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D012529:Saudi Arabia; D013472:Sunlight; D013746:Tetany / Q000209:etiology; D014807:Vitamin D / Q000008:administration & dosage
D002136:Calcium, Dietary; D014807:Vitamin D; D015652:25-Hydroxyvitamin D 2; D010758:Phosphorus; D000469:Alkaline Phosphatase