Skip to main content
British Medical Journal logoLink to British Medical Journal
. 1973 Feb 10;1(5849):324–327. doi: 10.1136/bmj.1.5849.324

Serum Alkaline Phosphatase and Rickets in Urban Schoolchildren

W T Cooke, C H J Swan, P Asquith, V Melikian, W E McFeely
PMCID: PMC1588178  PMID: 4685622

Abstract

Among 569 schoolchildren (386 boys and 183 girls) aged 14-17 years, 233 had serum alkaline phosphatase values of 30 K.A. units or greater. There was no significant difference in the results in Asian, white, or West Indian children. The mean values were significantly greater in boys than girls and both showed a fall in mean values with increasing age. Radiological rickets occurred in at least 4% of the survey, and was more common in Asians. Low calcium and high hydroxyproline excretion in most of those investigated and the response to vitamin D therapy suggests that most children with alkaline phosphatase levels above 30 K.A. units have rickets.

Since the decline of the widespread supplementation of the diet with vitamin D, the demands of the physiological growth spurt for extra vitamin D in adolescents already on a borderline intake may be responsible for the great increase in “biochemical” rickets. Once the growth spurt is over the condition subsides but the results of impaired growth or permanent pelvic deformity will not necessarily be eradicated.

Full text

PDF

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BENSON P. F., STROUD C. E., MITCHELL N. J., NICOLAIDES A. Rickets in immigrant children in London. Br Med J. 1963 Apr 20;1(5337):1054–1056. doi: 10.1136/bmj.1.5337.1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Belfield A., Goldberg D. M. Normal ranges and diagnostic value of serum 5'nucleotidase and alkaline phosphatase activities in infancy. Arch Dis Child. 1971 Dec;46(250):842–846. doi: 10.1136/adc.46.250.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. CHILDS B., CANTOLINO S., DYKE M. K. Observations on sex differences in human biology. Bull Johns Hopkins Hosp. 1962 Mar;110:134–144. [PubMed] [Google Scholar]
  4. DUNNIGAN M. G., PATON J. P., HAASE S., McNICOL G. W., GARDNER M. D., SMITH C. M. Late rickets and osteomalacia in the Pakistani community in Glasgow. Scott Med J. 1962 Apr;7:159–167. doi: 10.1177/003693306200700402. [DOI] [PubMed] [Google Scholar]
  5. FOLLIS R. H., Jr, PARK E. A., JACKSON D. The prevalence of rickets at autopsy during the first two years of age. Bull Johns Hopkins Hosp. 1952 Dec;91(6):480–497. [PubMed] [Google Scholar]
  6. Ford J. A., Colhoun E. M., McIntosh W. B., Dunnigan M. G. Biochemical response of late rickets and osteomalacia to a chupatty-free diet. Br Med J. 1972 Aug 19;3(5824):446–447. doi: 10.1136/bmj.3.5824.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ford J. A., Colhoun E. M., McIntosh W. B., Dunnigan M. G. Rickets and osteomalacia in the Glasgow Pakistani community, 1961-71. Br Med J. 1972 Jun 17;2(5815):677–680. doi: 10.1136/bmj.2.5815.677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. HOFFMANN R. G. STATISTICS IN THE PRACTICE OF MEDICINE. JAMA. 1963 Sep 14;185:864–873. doi: 10.1001/jama.1963.03060110068020. [DOI] [PubMed] [Google Scholar]
  9. JASIN H. E., FINK C. W., WISE W., ZIFF M. Relationship between urinary hydroxyproline and growth. J Clin Invest. 1962 Oct;41:1928–1935. doi: 10.1172/JCI104650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Loomis W. F. Skin-pigment regulation of vitamin-D biosynthesis in man. Science. 1967 Aug 4;157(3788):501–506. doi: 10.1126/science.157.3788.501. [DOI] [PubMed] [Google Scholar]
  11. PRINEAS J. W., MASON A. S., HENSON R. A. MYOPATHY IN METABOLIC BONE DISEASE. Br Med J. 1965 Apr 17;1(5441):1034–1036. doi: 10.1136/bmj.1.5441.1034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Sereny G., McLaughlin L. Serum alkaline phosphatase values in normal adolescents. Can Med Assoc J. 1970 Jun 20;102(13):1400–1401. [PMC free article] [PubMed] [Google Scholar]
  13. Smith R., Dick M. Total urinary hydroxyproline in osteomalacia and the effect upon it of treatment with vitamin D. Clin Sci. 1968 Feb;34(1):43–56. [PubMed] [Google Scholar]
  14. Tanner J. M., Whitehouse R. H., Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. Arch Dis Child. 1966 Dec;41(220):613–635. doi: 10.1136/adc.41.220.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Thomas P. K. Metabolic myopathy. Postgrad Med J. 1967 Feb;43(496):103–110. doi: 10.1136/pgmj.43.496.103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Wills M. R., Phillips J. B., Day R. C., Bateman E. C. Phytic acid and nutritional rickets in immigrants. Lancet. 1972 Apr 8;1(7754):771–773. doi: 10.1016/s0140-6736(72)90523-5. [DOI] [PubMed] [Google Scholar]
  17. Zorab P. A. Normal creatinine and hydroxyproline excretion in young persons. Lancet. 1969 Nov 29;2(7631):1164–1165. doi: 10.1016/s0140-6736(69)92487-8. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES