title: Comparison of Limestone and Ground Fish for Treatment of Nutritional Rickets in Children in Nigeria.
abstract: OBJECTIVE
  To determine whether children with calcium-deficiency rickets respond better to treatment with calcium as limestone or as ground fish.
  
  
  METHODS
  Nigerian children with active rickets (n = 96) were randomized to receive calcium as powdered limestone (920 mg of elemental calcium) or ground fish (952 mg of elemental calcium) daily for 24 weeks. Radiographic healing was defined as achieving a score of 1.5 or less on a 10-point scale.
  
  
  RESULTS
  The median (range) age of enrolled children was 35 (6-151) months. Of the 88 children who completed the study, 29 (66%) in the ground fish group and 24 (55%) in the limestone group achieved the primary outcome of a radiographic score of 1.5 or less within 6 months (P = .39). The mean radiographic score improved from 6.2 ± 2.4 to 1.8 ± 2.2 in the ground fish group and from 6.3 ± 2.2 to 2.1 ± 2.4 in the limestone group (P = .68 for group comparison). In an intention to treat analysis adjusted for baseline radiographic score, age, milk calcium intake, and serum 25-hydroxyvitamin D concentration, the response to treatment did not differ between the 2 groups (P = .39). Younger age was associated with more complete radiographic healing in the adjusted model (aOR 0.74 [95% CI 0.57-0.92]). After 24 weeks of treatment, serum alkaline phosphatase had decreased, calcium and 25-hydroxyvitamin D increased, and bone mineral density increased in both groups, without significant differences between treatment groups.
  
  
  CONCLUSIONS
  In children with calcium-deficiency rickets, treatment with calcium as either ground fish or limestone for 6 months healed rickets in the majority of children.
authors: Department of Family Medicine, Mayo Clinic, Rochester, MN. Electronic address: thacher.thomas@mayo.edu.
authors: Tom D
authors: TD
authors: Thacher
authors: Mayo Medical School, Mayo Clinic, Rochester, MN.
authors: Tanner J
authors: TJ
authors: Bommersbach
authors: Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors: John M
authors: JM
authors: Pettifor
authors: Department of Chemical Pathology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria.
authors: Christian O
authors: CO
authors: Isichei
authors: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors: Philip R
authors: PR
authors: Fischer
mesh_terms: D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D002118:Calcium / Q000097:blood / Q000172:deficiency; D002119:Calcium Carbonate / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003890:Desiccation; D019587:Dietary Supplements; D005260:Female; D005396:Fish Products; D006801:Humans; D007223:Infant; D008297:Male; D009549:Nigeria; D011208:Powders; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging; D012279:Rickets / Q000000981:diagnostic imaging / Q000628:therapy*; D014457:Ulna / Q000000981:diagnostic imaging; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D011208:Powders; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002119:Calcium Carbonate; D002118:Calcium