title: Safety and Efficacy of Stosstherapy in Nutritional Rickets.
abstract: OBJECTIVE
  Stosstherapy has been used since early 19thcentury for treating nutritional rickets. However, there are no clear cut guidelines for the biochemical monitoring of this treatment. Repeated blood tests at short intervals increase the cost of therapy and noncompliance.
  
  
  METHODS
  A prospective study was conducted on 191 cases of nutritional rickets below 10 years of age to evaluate the effectivity of stosstherapy. All cases were treated with a single intramuscular injection of vitamin D (600.000 IU) along with oral calcium (50 mg/kg) and vitamin D (400 IU per day) until radiological resolution. Dietary modifications and adequate sunlight exposure were also recommended.
  
  
  RESULTS
  The mean age of presentation was 2 years 9 months. Mean sunlight exposure was 17 minutes/week with 90% having low sunlight exposure (<30 minutes/week). Prolonged breast feeding (>6 months) was found in 93.7% of the cases. With treatment, the clinical features started resolving by 1 month with complete resolution of most of the features over a period of 1 year. By 6 months, all the study subjects had complete radiological resolution. Serum levels of calcium and alkaline phosphatase (ALP) were restored by 6 months in most cases while phosphate and vitamin D levels normalized by 6 weeks.
  
  
  CONCLUSIONS
  Stosstherapy is a safe, cheap and effective method of treating nutritional rickets. Biochemical tests at initial presentation followed by vitamin D assay at 6 weeks and calcium, phosphate and ALP assays at 6 months is recommended in the monitoring of these patients. For regular monitoring, only ALP assay is recommended, provided one abstains from repeat injection of vitamin D based on high ALP levels.
authors.affiliation: Vardhaman Mahavir Medical College, Department of Orthopedics, New Delhi, India Phone: 9007930192 E-mail: daipayan27@yahoo.co.in.
authors.forename: Daipayan
authors.initials: D
authors.lastname: Chatterjee
authors.forename: Mathad K S
authors.initials: MK
authors.lastname: Swamy
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Vasu
authors.initials: V
authors.lastname: Sharma
authors.forename: Akshat
authors.initials: A
authors.lastname: Sharma
authors.forename: Krishti
authors.initials: K
authors.lastname: Chatterjee
mesh_terms: D000284:Administration, Oral; D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D011446:Prospective Studies; D012279:Rickets / Q000188:drug therapy*; D013472:Sunlight; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use*; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium