Demographic Characteristics, Risk Factors, and Presenting Features of Children with Symptomatic Nutritional Rickets: A French Series

2020 ◽  
Vol 93 (5) ◽  
pp. 304-312
Author(s):  
Claire Flot ◽  
Valérie Porquet-Bordes ◽  
Justine Bacchetta ◽  
Anya Rothenbuhler ◽  
Anne Lienhardt-Roussie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Pediatric Population ◽  
Vitamin D Supplementation ◽  
Demographic Characteristics ◽  
Total Serum ◽  
Nutritional Rickets ◽  
Total Serum Calcium ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D

<b><i>Aim:</i></b> To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. <b><i>Methods:</i></b> This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. <b><i>Results:</i></b> We observed a higher frequency of rickets in males (74 vs. 26%), in young children (median age at diagnosis: 23 months; 82% were younger than 5 years), and in children with a non-Caucasian ethnic background (89%). Most children were exclusively breastfed (78%) without adequate vitamin D supplementation (89%). The most common presentations were bowed legs (63%), hypocalcemic seizures (21%), and growth retardation (11%). Approximately half (62%) of the children were hypocalcemic. The children presenting with hypocalcemic seizures were significantly younger (0.8 vs. 2.2 years; <i>p</i> = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; <i>p</i> &#x3c; 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; <i>p</i> = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; <i>p</i> = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; <i>p</i> = 0.940) compared to rickets cases who did not experience hypocalcemic seizures. A dilated cardiomyopathy was detected in 14% of the children who had undergone echocardiography. <b><i>Conclusion:</i></b> Nutritional rickets remains endemic in the pediatric population and its most severe forms can have life-threatening sequelae. Health practitioners need to be cognizant of these facts to raise awareness and screen high-risk populations.

scholarly journals Hypovitaminosis D in Healthy Health Care Professionals: A Real Deficiency or Necessity of New Reference Value for Specific Population?

2018 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Rajendra Dev Bhatt ◽  
Nikita Pradhan ◽  
Rojeena Gurung ◽  
Prabodh Risal
Keyword(s):  
Health Care ◽  
Vitamin D ◽  
Health Care Professionals ◽  
Pearson Correlation ◽  
Significant Proportion ◽  
Reference Value ◽  
Total Serum ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Apparently Healthy

Introduction: Vitamin D, a steroid vitamin, has attracted noticeable interest of clinicians and researchers for decades because of its diverse array of biological functions. Various studies have shown that the level of vitamin D is low in significant proportion of healthy individuals. However, indoor workers especially health care professionals are not focused, particularly in Nepal. We aimed to measure level of vitamin D in apparently healthy health care professionals. Methods: A descriptive cross-sectional study was carried out in apparently healthy health care professionals working at Kathmandu University Hospital in Dhulikhel, Nepal. Structured questionnaire including socio­demographics, dietary habits, and anthropometric measurements was filled in by the participants. Total serum 25-hydroxy vitamin D was measured by Chemiluminescence Immunoassay (CLIA) technique. Results were analyzed with t-test, Chi-square test, and Pearson correlation test. Results: Data from 64 female and 47 male were analyzed, mean 25-hydroxy vitamin D level was 8.81 ng/dl (SD = 4). Almost all (98.2%, n = 109) participants had vitamin D lower than normal where 72.7% (n = 92) were deficient, 24.5% (n = 17) were insufficient, and only 2.7% (n = 2) were having adequate level. Non-specific body pain was the only factor among all we studied that was significantly associated with vitamin D levels (p = 0.002). Conclusion: Hypovitaminosis of 25-hydroxy vitamin D was found to be very common (98.2%) in apparently healthy health care subjects of Dhulikhel Hospital. This may necessitate further research to redefine the biological reference value for our population.

Late Onset Hypocalcemic Seizures in Formula-Fed, Vitamin D Deficient Babies: Revisited

2020 ◽  
Vol 34 (1-2) ◽  
pp. 15-18
Author(s):  
Umar Amin Qureshi ◽  
Abdus Sami Bhat ◽  
Muzaffar Jan ◽  
Uruj Qureshi
Keyword(s):  
Vitamin D ◽  
Breast Feeding ◽  
Serum Calcium ◽  
Late Onset ◽  
Response To Treatment ◽  
Total Serum ◽  
Total Serum Calcium ◽  
Vitamin D Levels ◽  
Calcium Phosphorus ◽  
25 Oh Vitamin D

Purpose: Late onset neonatal hypocalcemia (LNH) is defined as hypocalcemia detected after day 3 of life. Its occurrence in babies fed with cow’s milk is well understood. Since the advent of modern-day formulas, the incidence has however decreased. Methods: A prospective descriptive study (January 2017 to December 2017) of LNH seizures in neonates was conducted. LNH was defined as the total serum calcium of less than 7 mg/dL in preterm or less than 8 mg/dL in term newborns after 72 h of life. Results: 14 neonates were presented with myoclonic and focal seizures due to late hypocalcemia. All were formula fed. Their mean serum calcium, phosphorus, alkaline phosphatase, magnesium, 25-OH vitamin D, intact PTH levels were 4.93 mg/dL, 9.19 mg/dL, 244 U/L, 1.2 mg/dL, 30 nmol/L, 38.6 pg/mL, respectively. Mean maternal vitamin D levels were 43 nmol/L. Mean hospital stay was 4 days. Clinical response to treatment was brisk in those who were able to shift to total breast feeding early. Conclusions: LNH in formula-fed and vitamin D deficient babies is not uncommon. Emphasis should be laid on exclusive breast feeding even in vitamin D deplete mothers. However, mothers at risk should be supplemented with vitamin D during pregnancy.

scholarly journals Spiral Fracture in Young Infant Causing a Diagnostic Dilemma: Nutritional Rickets versus Child Abuse

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Sonia Kaushal ◽  
Manish Raisingani ◽  
Raphael David ◽  
Bina Shah
Keyword(s):  
Vitamin D ◽  
Young Infant ◽  
Vitamin D Supplementation ◽  
Psychosocial Assessment ◽  
Diagnostic Dilemma ◽  
Elevated Alkaline Phosphatase ◽  
Spiral Fracture ◽  
Nutritional Rickets ◽  
Young Infants ◽  
Vitamin D Levels

Fractures are uncommon in young, nonambulatory infants. The differential diagnosis includes nonaccidental injury (NAI) and metabolic bone disease, including rickets. While rickets typically present after six months of age, multiple cases have been reported in younger infants. We report a case of an 11-week-old male infant who presented with a spiral fracture of the humerus and no radiologic evidence of rickets. A detailed psychosocial assessment failed to reveal any risk factors for NAI. The patient had elevated alkaline phosphatase and PTH with low 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D levels. Additionally, the mother was noncompliant with prenatal vitamins, exclusively breastfeeding without vitamin D supplementation, and had markedly low vitamin D levels 15 weeks postpartum. The biochemical data and history were consistent with rickets. Given the diagnostic dilemma, the working diagnosis was rickets and the patient was started on ergocalciferol with subsequent normalization of his laboratory values and healing of the fracture. These findings are consistent with nutritional rickets largely due to maternal-fetal hypovitaminosis D. This case highlights that in young infants rickets should be considered even in the absence of positive radiologic findings. Additionally, it illustrates the importance of maintaining adequate vitamin D supplementation during pregnancy and early infancy.

The Spectrum of Vitamin D Deficiency: Description of a Family

2017 ◽  
Vol 125 (07) ◽  
pp. 478-484 ◽  
Author(s):  
Francesco Vierucci ◽  
Marta Del Pistoia ◽  
Emioli Randazzo ◽  
Francesco Massart ◽  
Giovanni Federico
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
High Risk ◽  
Global Health ◽  
Vitamin D Deficiency ◽  
Family Members ◽  
Vitamin D Supplementation ◽  
Nutritional Rickets ◽  
Clinical Pictures ◽  
Global Health Problem

Abstract Background Vitamin D deficiency represents a global health problem, affecting children and adolescents worldwide. Objects To confirm that vitamin D deficiency can present as a spectrum of clinical pictures. Methods We diagnosed nutritional rickets in a 10-month-old infant of Senegal origin with several risk factors for vitamin D deficiency. As many of these factors affected also his cohabitant relatives, we evaluate infant’s family members (mother and 4 brothers) looking for other vitamin D deficiency-related comorbidities. Results 3 brothers had asymptomatic vitamin D deficiency and 2 of them (9.8 and 13.4 years-old) showed secondary hyperparathyroidism. The fourth brother (11.3 years-old) had nutritional rickets. Their mother was affected by osteomalacia. None of them received vitamin D supplementation. Conclusion Vitamin D deficiency may present as a spectrum of clinical pictures, representing a continuum ranging from asymptomatic/subtle conditions to overt rickets/osteomalacia. Immigrant families are at high risk for vitamin D deficiency at every age. If a case of symptomatic vitamin D deficiency is recognized, then the evaluation of the all family members is recommended, as they can have the same and/or other risk factors for vitamin D deficiency.

scholarly journals Inflammatory activity and vitamin D levels in an MS population treated with rituximab

2019 ◽  
Vol 5 (1) ◽  
pp. 205521731982659 ◽  
Author(s):  
Johan Linden ◽  
Gabriel Granåsen ◽  
Jonatan Salzer ◽  
Anders Svenningsson ◽  
Peter Sundström
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Magnetic Resonance ◽  
Vitamin D Supplementation ◽  
Inflammatory Activity ◽  
T2 Lesions ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Multiple Sclerosis Patients

Background Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed. Objective To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels. Methods Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health. Results In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health ( r = 0.18, P = 0.041, n = 130) and C-reactive protein ( r = –0.13, P = 0.042) but not with the risk of side effects. Conclusion The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.

scholarly journals Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Jonathan D. Adachi ◽  
Jacques P. Brown ◽  
George Ioannidis
Keyword(s):  
Vitamin D ◽  
Clinical Practice ◽  
Bone Health ◽  
Chart Review ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Vitamin D Supplements

Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients’ current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health.

Genetic Variation in CYP2R1 and GC Genes Associated With Vitamin D Deficiency Status

2016 ◽  
Vol 30 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Nicole A. Slater ◽  
Michelle L. Rager ◽  
Dawn E. Havrda ◽  
Arthur F. Harralson
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Total Serum ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D ◽  
Variant Alleles

This cross-sectional study enrolled 180 patients at a private family practice in Virginia. Total serum vitamin D concentrations were obtained weekly from January 30, 2013, through March 30, 2013, in consecutive patients regularly scheduled for laboratory work at the practice. Patients were categorized into 2 groups and analyzed for variant alleles in vitamin D receptor ( VDR; rs2228570), cytochrome P450 2R1 ( CYP2R1; rs10741657), 7-dehydrocholesterol reductase ( DHCR7; rs12785878), and group-specific component ( GC; rs2282679) to determine whether variants of those alleles influenced total serum 25(OH)D concentrations. One-hundred and eighty patients were enrolled, with 40 (22%) being sufficient, 25-hydroxy vitamin D level 25(OH)D ≥ 30 ng/mL, and 140 (78%) being insufficient, 25(OH)D < 30 ng/mL. Of the 4 genes, 2 genes, CYP2R1 (rs10741657) and GC (rs2282679), demonstrated a significant association related to vitamin D status. Subjects with 1 or more variant alleles at rs10741657 were almost 3.7 (odds ratio [OR] 3.67; 95% confidence interval [CI]: 1.35-9.99) times more likely be insufficient in vitamin D and subjects with 1 or more variant alleles at rs2282679 were about half (OR 0.42; 95% CI: 0.18-0.93) as likely to be insufficient in vitamin D. Allelic variations in CYP2R1 (rs10741657) and GC (rs2282679) affect vitamin D levels, but variant alleles on VDR (rs2228570) and DHCR7 (rs12785878) were not correlated with vitamin D deficiency, 25(OH)D < 30 ng/mL.

Influence of Ultraviolet Radiation on the Association between 25-Hydroxy Vitamin D Levels and Cardiovascular Risk Factors in Obesity

2016 ◽  
Vol 171 ◽  
pp. 83-89.e1 ◽  
Author(s):  
Flavia Prodam ◽  
Sara Zanetta ◽  
Roberta Ricotti ◽  
Agostina Marolda ◽  
Enza Giglione ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Cardiovascular Risk ◽  
Ultraviolet Radiation ◽  
Cardiovascular Risk Factors ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D
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