title: Management of nutritional rickets in Indian children: a randomized controlled trial.
abstract: BACKGROUND
  Rickets is usually attributed to vitamin D deficiency. However, recent studies have implicated dietary calcium deficiency in its etiology. Information on relative efficacy of calcium, vitamin D or both together in healing of rickets is limited.
  
  
  OBJECTIVE
  To study effect of treatment with calcium, vitamin D or a combination of these two on healing of nutritional rickets in young children.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Sixty-seven cases of nutritional rickets in the age group of 6 months to 5 years were randomly allocated to receive vitamin D (600 000 IU single intramuscular dose), calcium (75 mg/kg/day elemental calcium orally) or a combination of the above two for a period of 12 weeks. The demographic parameters, nutritional status, dietary calcium and phytate intake were assessed for all. Radiographs (wrist and knee) and biochemical parameters (serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxycholecalciferol and parathyroid hormone) were evaluated at baseline, 6 and 12 weeks for evidence of healing.
  
  
  RESULTS
  Mean dietary intake of calcium in all cases was low (204 ± 129 mg/day). Mean serum 25-hydroxycholecalciferol D level was 15.9 ± 12.4 ng/ml, and 82.1% of patients had serum vitamin D levels <20 ng/ml, indicative of vitamin D deficiency. After 6 and 12 weeks of treatment, radiological and biochemical evidence of healing rickets was observed in all treatment groups, albeit to a variable extent. The combined end point of normal serum alkaline phosphatase and complete radiological healing at 12 weeks was observed in 50% subjects on combination therapy as compared with 15.7% subjects on vitamin D alone and 11.7% on calcium alone.
  
  
  CONCLUSIONS
  Children with rickets had a low serum vitamin D level and a low dietary calcium intake. The best therapeutic response was seen with a combination of vitamin D and calcium than either of them given alone.
  
  
  BACKGROUND
  CTRI/2010/091/000448.
authors.affiliation: Department of Pediatrics, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Aggarwal
authors.forename: Anju
authors.initials: A
authors.lastname: Seth
authors.forename: Raman K
authors.initials: RK
authors.lastname: Marwaha
authors.forename: Bhavna
authors.initials: B
authors.lastname: Sharma
authors.forename: Pitamber
authors.initials: P
authors.lastname: Sonkar
authors.forename: Satveer
authors.initials: S
authors.lastname: Singh
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000008:administration & dosage* / Q000097:blood; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009752:Nutritional Status; D010710:Phosphates / Q000097:blood; D012279:Rickets / Q000097:blood / Q000188:drug therapy*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage* / Q000097:blood
chemical_list: D015415:Biomarkers; D010710:Phosphates; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium