title: Rachitic changes, demineralization, and fracture risk in healthy infants and toddlers with vitamin D deficiency.
abstract: OBJECTIVE
  To examine radiographic findings in children with vitamin D deficiency in comparison with biochemical marker levels and prevalence of fractures.
  
  
  METHODS
  The parents or guardians of all participants provided written informed consent at the time of enrollment. The institutional review board approved the protocol, and HIPAA guidelines were followed. From a prospective sample of children seen for routine clinical care, 40 children with vitamin D deficiency (25-hydroxyvitamin D [25-OHD] level, ≤ 20 ng/mL) were identified, and high-detail computed radiographs of the wrists and knees were obtained. The children ranged in age from 8 to 24 months. Radiographs were scored by three readers with use of the 10-point Thacher score for rachitic changes and a five-point scale for demineralization. Serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels were determined. Fracture history was obtained for 35 of the 40 patients (88%).
  
  
  RESULTS
  All readers identified rachitic changes at both readings in two patients (5%) and demineralization in two patients (5%). Interrater agreement was 65% for rachitic changes (κ = 0.33) and 70% for demineralization (κ = 0.37). When the majority of the raters determined that rachitic changes were absent at both readings, alkaline phosphatase levels were lower than those with other assessments (median, 267 vs 515 U/L [4.4589 vs 8.6005 μkat/L]; P = .01). When most raters determined that demineralization was present at both readings, serum 25-OHD levels were lower than those at other assessments (median, 9.0 vs 17.5 ng/mL [22.464 vs 43.68 nmol/L]; P = .02). No fractures were reported or identified radiographically.
  
  
  CONCLUSIONS
  In infants and toddlers with vitamin D deficiency, rachitic changes and definite demineralization are uncommon and fracture risk is low.
authors: Department of Radiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. Jeannette.Perez-Rossello@childrens.harvard.edu
authors: Jeannette M
authors: JM
authors: Perez-Rossello
authors: Henry A
authors: HA
authors: Feldman
authors: Paul K
authors: PK
authors: Kleinman
authors: Susan A
authors: SA
authors: Connolly
authors: Rick A
authors: RA
authors: Fair
authors: Regina M
authors: RM
authors: Myers
authors: Catherine M
authors: CM
authors: Gordon
mesh_terms: D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D015995:Prevalence; D011859:Radiography; D012279:Rickets / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers