The validity of serum alkaline phosphatase to identify nutritional rickets in Nigerian children on a calcium-deprived diet

Abstract Context Nutritional rickets results from the interaction of low vitamin D status and limited calcium intake. Serum alkaline phosphatase (AP) activity is a biomarker of impaired mineralization in rickets. Objective To assess the performance of serum AP activity in identifying nutritional rickets in calcium-deprived Nigerian children. Design, setting, and participants We reanalyzed data from a case-control study of children with active rickets and matched control subjects without rickets, using a multivariate logistic regression to assess the odds of rickets associated with AP activity, adjusting for age, sex, and weight for age z-score. Results A total of 122 children with rickets and 119 controls were included. Rachitic children had a mean (±SD) age of 54±29 months, and 55 (45.1%) were male. Cases and controls had low dietary calcium intakes (216±87 and 214±96 mg/day, respectively). Serum AP activity levels in cases and controls were 812±415 and 245±78 U/L, respectively (P<0.001). AP was negatively associated with 25-hydroxyvitamin D values (r=-0.34; P<0.001). In the adjusted model, the odds ratio (95% confidence interval) for rickets was 6.7 (4.1-12.2) for each 100 U/L increase in AP. The area under the receiver operating characteristic curve was 0.978. AP >350 U/L identified nutritional rickets in Nigerian children with sensitivity 0.93, specificity 0.92, positive likelihood ratio 11.3, and negative likelihood ratio 0.07. Conclusions An AP >350 U/L effectively discriminated between Nigerian children with and without nutritional rickets. AP is a low-cost biochemical test that could be used to screen for nutritional rickets, but cut-off values require validation in other populations, and laboratory values need to be standardized for widespread population studies.

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COMPARISON OF THE PARENTERAL AND ORAL VITAMIN D SUPPLEMENTATION IN THE TREATMENT OF NUTRITIONAL RICKETS IN TERMS OF MEAN CHANGE IN SERUM CALCIUM, PHOSPHORUS, AND ALKALINE PHOSPHATASE

Journal of University Medical & Dental College ◽

10.37723/jumdc.v12i2.517 ◽

2021 ◽

Vol 12 (2) ◽

Author(s):

Nisar Khan Sajid ◽

Sumaira Tehseen ◽

Tahir Mehmood ◽

Tanveer Ahmed ◽

Ramsha Abbas ◽

...

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Serum Calcium ◽

Serum Alkaline Phosphatase ◽

Oral Route ◽

Vitamin D Supplementation ◽

Serum Phosphorus ◽

Oral Vitamin ◽

Baseline Serum ◽

Nutritional Rickets

ABSTRACT: BACKGROUND & OBJECTIVE: Rickets is a common presentation on the pediatric floor, with nutritional rickets being the cause of leading significant morbidity, disability, especially in the developing countries of the world. The objective is to compare the efficacy of parenteral and oral vitamin D supplementation in the treatment of nutritional rickets METHODOLOGY: This comparative interventional, prospective analysis was conducted at Aziz Fatimah Hospital Faisalabad (1-1-2017 to 30-6-2017) outdoor patients divided into parenteral and oral groups. All of the outcome variables were measured at baseline and one month after treatment. RESULTS: In this study, mean age was calculated as 2.12 + 0.76 years and 2.15+0.77 in parental and oral groups respectively. 49.29% (n=69) and 45%(n=63) were male and 50.71%(n=71) and 55% (n=77) were female respectively in both groups. At baseline, serum calcium was 8.68 + 0.35 and 8.71 + 0.37 (p=0.62) serum phosphorus was 3.92 + 9.22 and 3.84 + 0.20 (p=0.03), and serum alkaline phosphatase was 230.01 + 13.09 and 228.89 + 13.80 (p=0.48) in parenteral and oral groups respectively. After treatment the mean change seen in serum calcium was 1.14 + 0.26 and 0.72 + 0.19 (p=0.001), serum phosphorus was 1.42 + 0.33 and 0.71 + 0.26 (p=0.001), serum Alkaline phosphatase was 79.48 + 14.84 and 23.65 + 12.21 (p=0.001) in parenteral and oral groups respectively. CONCLUSION: We concluded that the parenteral route for vitamin. D supplementation is significantly better than the oral route in treating nutritional rickets in terms of mean change in serum calcium, serum phosphorus, and serum alkaline phosphatase.

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Effect of vitamin D and calcium alone or in combination in the treatment of nutritional rickets

BIRDEM Medical Journal ◽

10.3329/birdem.v11i1.51028 ◽

2020 ◽

Vol 11 (1) ◽

pp. 39-46

Author(s):

Fatema Yasmin ◽

Farzana Yasmin ◽

Fahmida Chowdhury ◽

Mujibul Hoque ◽

Minakshi Chowdhury ◽

...

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Serum Alkaline Phosphatase ◽

Female Ratio ◽

Nutritional Rickets ◽

Radiographic Score ◽

Significant Difference ◽

Group A ◽

Group B

Background: Nutritional rickets has emerged as a public health problem in Bangladesh during the past two decades, with up to 8% of children being clinically affected in some areas. Insufficiency of vitamin D and dietary calcium is thought to be the underlying cause. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. Calcium alone or in combination with vitamin D has also been used in the treatment of nutritional rickets. So this study was done to assess the effects of vitamin D, calcium or combination of vitamin D and calcium for the treatment of nutritional rickets in Bangladeshi children. Methods: This open labeled randomized comparative study was done in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital from July 1, 2010 to June 30, 2012 A total 48 rickets patient was enrolled in this study. After selection of cases patients were divided in to three groups by lottery method. Group A received single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock), Group B received calcium (750 mg per day) for 6 weeks and Group C received both calcium (750 mg per day) for 6 weeks and single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock). Response was evaluated by serum alkaline phosphatase level and using 10-point radiographic score developed by Thacher and colleagues at baseline, 6 weeks, and 12 weeks. Results: Mean age of the study participants was 35.83 months. Male to female ratio was 2:1. The radiographic score was significantly improved in first and second follow up (p<0.001) in all groups. But there was significant difference of improvement in Group C than Group A and Group B. In Group C, the percent reduction from base to first follow up was 80.05±7.04 and 90.65±3 in second follow up which showed quick improvement in combination therapy. Serum alkaline phosphatase also significantly reduced in all three groups. Conclusion: Combination use of vitamin D and calcium in the treatment of nutritional rickets is more effective than prescribing either vitamin D or calcium alone. Birdem Med J 2021; 11(1): 39-46

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Serum Alkaline Phosphatase in Liver Disease: A Concept of its Significance

Gastroenterology ◽

10.1016/s0016-5085(19)36477-7 ◽

1950 ◽

Vol 16 (4) ◽

pp. 660-668 ◽

Cited By ~ 22

Author(s):

James O. Burke

Keyword(s):

Alkaline Phosphatase ◽

Liver Disease ◽

Serum Alkaline Phosphatase

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The Origin of Elevation of Serum Alkaline Phosphatase in Hepatic Disease

Gastroenterology ◽

10.1016/s0016-5085(62)80053-5 ◽

1962 ◽

Vol 42 (4) ◽

pp. 431-438 ◽

Cited By ~ 49

Author(s):

Stanton G. Polin ◽

Mitchell A. Spellberg ◽

Lloyd Teitelman ◽

Makoto Okumura

Keyword(s):

Alkaline Phosphatase ◽

Serum Alkaline Phosphatase ◽

Hepatic Disease

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SUBACUTE THYROIDITIS WITH ELEVATED SERUM ALKALINE PHOSPHATASE LEVEL

Acta Endocrinologica ◽

10.1530/acta.0.xxxiv0256 ◽

1960 ◽

Vol XXXIV (II) ◽

pp. 256-260

Author(s):

Jörgen Herman Vogt

Keyword(s):

Alkaline Phosphatase ◽

Alkaline Phosphatase Level ◽

Serum Alkaline Phosphatase ◽

Thyroid Tissue ◽

Elevated Serum ◽

Subacute Thyroiditis ◽

Serum Alkaline Phosphatase Level ◽

Transient Rise

ABSTRACT A case of subacute thyroiditis is recorded, in which a transient rise in serum alkaline phosphatase values leads to the hypothesis of a transient parathyroid hyper-activity induced by the inflammation of the thyroid tissue in which the parathyroid may be embedded.

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Paget’s disease: clinical update

Orvosi Hetilap ◽

10.1556/oh.2011.29174 ◽

2011 ◽

Vol 152 (33) ◽

pp. 1337-1346

Author(s):

Judit Donáth ◽

Gyula Poór

Keyword(s):

Alkaline Phosphatase ◽

Serum Alkaline Phosphatase ◽

Paget’S Disease ◽

Paget's Disease ◽

Etiologic Role ◽

Osteoblast Activity ◽

Chronic Disorder ◽

Abnormal Increase ◽

Osteoclast Function ◽

High Level

Paget’s disease is a chronic disorder of bone remodeling, characterized by an abnormal increase of osteoclast and, hence, osteoblast activity. The imbalance of bone turnover results in the formation of unhealthy and fragile bone. It also leads to impairment of adjacent joints and to a risk of various complications. Current research focuses on the elucidation of the etiologic role viral infection and predisposing genetic factors. Paget’s disease is commonly discovered by chance; its suspicion is raised either by high level of alkaline phosphatase or by the X-ray of the pathological bone. Bisphosphonates have proven to be effective in controlling disease activity because they inhibit osteoclast function. Their use is recommended when bone-derived serum alkaline phosphatase is high and/or when disease localizations are highly suspected for the development of complications. Orv. Hetil., 2011, 152, 1337–1346.

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