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. 2003 Sep;88(9):812–817. doi: 10.1136/adc.88.9.812

Radiological and biochemical resolution of nutritional rickets with calcium

L Oginni 1, C Sharp 1, O Badru 1, J Risteli 1, M Davie 1, M Worsfold 1, P Fischer 1, L Oginni 1, O Badru 1, C Sharp 1, M Davie 1, M Worsfold 1, J Risteli 1
PMCID: PMC1719645  PMID: 12937108

Abstract

Aims: To determine the response to oral calcium in Nigerian children with rickets.

Methods: In a teaching hospital in Western Nigeria, 26 children (13 boys, 13 girls, aged 2–5 years) with confirmed rickets received calcium lactate (2.7 g/day).

Results: Within one month of treatment leg pain was relieved and the children were more active. The mean x ray score improved from 3.3 at baseline to 1.7 at three months and 0.9 at six months (arbitrary scoring system, 0–6). Twelve cases were healed radiologically after six months, 11 others improved considerably, two showed no significant improvement, and a non-compliant patient was worse. There was progressive reversal of biochemical features. Median plasma alkaline phosphatase fell from 519 (range 178–1078) to 283 (209–443) IU/l (p = 0.04) in four months, while mean 1,25-dihydroxyvitamin D fell from 473 (251–1057) to 281 (155–481) pmol/l (p = 0.04), and mean plasma calcium increased from 2.26 (1.63–2.54) to 2.37 (2.06–2.54) mmol/l (p = 0.13). Parathyroid hormone fell from 5.3 (0.4–21.5) to 1.7 (0.45–7.4) pmol/l. Type I collagen carboxy terminal cross linked telopeptide was very high at baseline (20 (7.2–103) to 14 (11–24) µg/l) (p = 0.03) and fell promptly to normal.

Conclusion: Calcium supplementation alone effected healing of rickets in most of these Nigerian children and may provide sufficient treatment in this environment.

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Figure 2.

Figure 2

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Serum bone markers: z scores relative to healthy controls.

Figure 3.

Figure 3

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Serum calcitrophic hormones: z scores relative to healthy controls.

Figure 1.

Figure 1

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x Ray appearances of the wrist and knee in a florid case of rickets; (A) before treatment, scored 6; (B) after six months of treatment, scored 1.

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

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