The Roles of Vitamin D and Dietary Calcium in Nutritional Rickets

Overview

Journal Bone Rep

Date 2018 Jun 30

PMID 29955625

Citations 4

Authors

Kebashni Thandrayen

John M Pettifor

Affiliations

Soon will be listed here.

Abstract

The etiology and pathogenesis of nutritional rickets are becoming progressively clearer. Vitamin D deficiency has generally been considered the major or only player in the pathogenesis of nutritional rickets. However, recent research into calcium deficiency has now provided clinicians with reasons to investigate and manage patients with nutritional rickets more appropriately. The important question when assessing cases of nutritional rickets is: "Is it calcium or vitamin D deficiency or both that play a major role in the pathogenesis of the disease?" The case presentation in this review highlights the risk factors, clinical presentation and pathophysiology of nutritional rickets in a young South African black child from a semi-urban area in Johannesburg, a city with abundant sunshine throughout the year.

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References

Wagner C, Greer F . Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008; 122(5):1142-52. DOI: 10.1542/peds.2008-1862. View

Thacher T, Fischer P, Pettifor J . Vitamin D treatment in calcium-deficiency rickets: a randomised controlled trial. Arch Dis Child. 2014; 99(9):807-11. PMC: 4145444. DOI: 10.1136/archdischild-2013-305275. View

Shah B, FINBERG L . Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr. 1994; 125(3):487-90. DOI: 10.1016/s0022-3476(05)83303-7. View

Patel P, Mughal M, Patel P, Yagnik B, Kajale N, Mandlik R . Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D3 (25OHD) concentration and parathyroid hormone (PTH) concentration. Arch Dis Child. 2015; 101(4):316-9. DOI: 10.1136/archdischild-2015-308985. View

Gill P, Kalia S . Assessment of the feasibility of using sunlight exposure to obtain the recommended level of vitamin D in Canada. CMAJ Open. 2015; 3(3):E258-63. PMC: 4593418. DOI: 10.9778/cmajo.20140037. View

Pettifor J . Privational rickets: a modern perspective. J R Soc Med. 1994; 87(12):723-5. PMC: 1294974. View

Clements M, Johnson L, Fraser D . A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature. 1987; 325(6099):62-5. DOI: 10.1038/325062a0. View

Wagner C, Hulsey T, Fanning D, Ebeling M, Hollis B . High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2007; 1(2):59-70. DOI: 10.1089/bfm.2006.1.59. View

Mittal H, Rai S, Shah D, Madhu S, Mehrotra G, Malhotra R . 300,000 IU or 600,000 IU of oral vitamin D3 for treatment of nutritional rickets: a randomized controlled trial. Indian Pediatr. 2014; 51(4):265-72. DOI: 10.1007/s13312-014-0399-7. View

10.

Stallings V, Oddleifson N, Negrini B, Zemel B, Wellens R . Bone mineral content and dietary calcium intake in children prescribed a low-lactose diet. J Pediatr Gastroenterol Nutr. 1994; 18(4):440-5. DOI: 10.1097/00005176-199405000-00006. View

11.

Thacher T, Smith L, Fischer P, Isichei C, Cha S, Pettifor J . Optimal Dose of Calcium for Treatment of Nutritional Rickets: A Randomized Controlled Trial. J Bone Miner Res. 2016; 31(11):2024-2031. DOI: 10.1002/jbmr.2886. View

12.

Cesur Y, Caksen H, Gundem A, Kirimi E, Odabas D . Comparison of low and high dose of vitamin D treatment in nutritional vitamin D deficiency rickets. J Pediatr Endocrinol Metab. 2003; 16(8):1105-9. DOI: 10.1515/jpem.2003.16.8.1105. View

13.

Munns C, Shaw N, Kiely M, Specker B, Thacher T, Ozono K . Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016; 101(2):394-415. PMC: 4880117. DOI: 10.1210/jc.2015-2175. View

14.

Wu F, Laslett L, Zhang Q . Threshold Effects of Vitamin D Status on Bone Health in Chinese Adolescents With Low Calcium Intake. J Clin Endocrinol Metab. 2015; 100(12):4481-9. DOI: 10.1210/jc.2015-2849. View

15.

Thacher T, Fischer P, Pettifor J . The usefulness of clinical features to identify active rickets. Ann Trop Paediatr. 2002; 22(3):229-37. DOI: 10.1179/027249302125001525. View

16.

Thacher T, Bommersbach T, Pettifor J, Isichei C, Fischer P . Comparison of Limestone and Ground Fish for Treatment of Nutritional Rickets in Children in Nigeria. J Pediatr. 2015; 167(1):148-54.e1. DOI: 10.1016/j.jpeds.2015.02.008. View

17.

Heyman M . Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006; 118(3):1279-86. DOI: 10.1542/peds.2006-1721. View

18.

Soliman A, De Sanctis V, Adel A, El Awwa A, Bedair S . Clinical, biochemical and radiological manifestations of severe vitamin d deficiency in adolescents versus children: response to therapy. Georgian Med News. 2012; (210):58-64. View

19.

Karras S, Anagnostis P, Bili E, Naughton D, Petroczi A, Papadopoulou F . Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era. Osteoporos Int. 2013; 25(3):795-805. DOI: 10.1007/s00198-013-2468-5. View

20.

Uush T . Calcium intake and serum calcium status in Mongolian children. J Steroid Biochem Mol Biol. 2014; 144 Pt A:167-71. DOI: 10.1016/j.jsbmb.2014.01.010. View