title: Subclinical rickets.
abstract: OBJECTIVE
  The study on sub clinical rickets is unique in the sense that it has not been preplanned conducted anywhere especially in Pakistan. The objective of present study was to explore the prevalence, gender and geographical distribution of sub clinical rickets and their related factors among school students.
  
  
  METHODS
  Out of total participants, 189(90%) students were finally included in the study from rural, urban and suburban high schools of Hazara Division, KPK. The age of boys and girls students was 11 years to 16 years. Anthropometrics data along with daily intakes of meal and availability of sun shine was noted on record form. Sub clinical cases were diagnosed with abnormal biochemical findings without physical indications of rickets.
  
  
  RESULTS
  Sub clinical rickets was found in 51(27%) students, out of which 15(8%) were boys and 36(19%) girls. Geographically, 26 cases of sub clinical rickets were from rural schools, 16 of urban and 09 found in suburban school. All sub clinical cases had serum level of sunshine vitamin D in between ≥18nmol/l to ≤39 nmol/l, but none of them had parathyroid level increased from upper normal range. Estimated quantities of vitamin D, calcium and phosphorus in daily intakes meal of boy's and girl's student were almost same and found less than recommended amount.
  
  
  CONCLUSIONS
  Sub clinical rickets is camouflagic rickets among Hazarian school students, especially in girl gender. The major cause contributed to this problem is lack of synergistic effect of Sunshine Vitamin D.
authors.affiliation: Tanveer Hussain Shah, PhD, Department of Biochemistry & Health Science, Hazara University Mansehra, KPK, Pakistan.
authors.forename: Tanveer Hussain
authors.initials: TH
authors.lastname: Shah
authors.affiliation: Mukhtiar Hassan, PhD, Department of Biochemistry & Health Science, Hazara University Mansehra, KPK, Pakistan.
authors.forename: Mukhtiar
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Tahir Saeed Siddiqui, FCPS, Ayub Medical College & Teaching Hospital, Abbottabad, Pakistan.
authors.forename: Tahir Saeed
authors.initials: TS
authors.lastname: Siddiqui
keywords: Camouflagic rickets; Daily meals; Hazarian school students; Physical indications; Sub clinical; Synergistic effect
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