Early adolescent nutritional rickets.
OBJECTIVE
To evaluate early adolescents with nutritional rickets and their responses to treatment.


METHODS
203 adolescents (aged 10 to 13 years) presenting with clinical features of lower-limb deformity, carpopedal spasm, joint swelling, a significant limp, or non-traumatic joint pain were screened for nutritional rickets. Multi-specialty examinations were performed. Family size, number of earning members, number and gender of children, preference for vegetarian food, composition of the meals, and the amount of milk consumed in a day were recorded. Radiographs of wrists, knees, ankles, and pelvis, as well as serum calcium, phosphate, and alkaline phosphatase levels were evaluated. The diagnosis of nutritional rickets was made based on a combination of clinical, radiological, and biochemical criteria, and confirmed by the responses to treatment. Children with nutritional rickets were treated by a single large intramuscular dose of vitamin D (600,000 IU) along with oral calcium and supplementary vitamin D as well as advice on diet and sunlight exposure.


RESULTS
40 females and 11 males were diagnosed as having nutritional rickets. 65% presented with bilateral knee pain with aggravation at night, 37% presented with lower-limb deformity, 24% had joint swelling especially at the wrist and ankle, 6% had a significant limp and walked with an antalgic gait secondary to pathological fractures. No patient reported carpopedal spasm. All patients had rachitic changes on radiographs in some but not all bones (100% in the ulna, 45% in the radius, 37% in the upper tibia, 37% in the lower fibula and 22% in the lower tibia). Three patients had pathological fractures. 55% had hypocalcaemia, 41% had hypophosphataemia and 100% had raised serum alkaline phosphatase levels. The mean time for biochemical resolution was 12 (range, 3-24) weeks. For radiological resolution it was 5 (range, 2-6) months, with the lower end of ulna being last to resolve.


CONCLUSIONS
Radiographs of the lower end of ulna and serum alkaline phosphatase levels can be used as a screening and monitoring tool for nutritional rickets in early adolescents. There may be a high prevalence of subclinical vitamin-D deficiency in our adolescent population.
Agarwal
Anil
A
Department of Orthopaedics, CNBC, Geeta Colony, Delhi, India. rachna_anila@yahoo.co.in
Gulati
Divesh
D
D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004032:Diet; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012279:Rickets / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D013472:Sunlight; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use
D015415:Biomarkers; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium