scholarly journals Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

2021 ◽  
Author(s):  
Hein Aung ◽  
Kyaw Soe ◽  
Frank F. Smithuis ◽  
Thomas Lamb ◽  
Moe Wint Aung ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Mineralization ◽  
Calcium Supplementation ◽  
Case Series ◽  
Calcium Deficiency ◽  
Elevated Alkaline Phosphatase ◽  
Hydroxyvitamin D ◽  
Nutritional Rickets ◽  
25 Hydroxyvitamin D ◽  
Childhood Condition

Rickets is an often-neglected, painful, and disabling childhood condition of impaired bone mineralization. In this case series we describe a cluster of 29 children with severe, painful bone deformities who live in the very remote region of Nagaland in northwest Myanmar. Children were found to have low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of the two. After treatment with vitamin D3 and calcium carbonate, significant improvement was seen in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in more than 120 years. Vitamin D and calcium supplementation, and food fortification for pregnant women and young children may be required to prevent this potentially devastating disease.

scholarly journals Osteomalacia in subtropical Auckland

2019 ◽  
Vol 12 (7) ◽  
pp. e229657
Author(s):  
Ravi K Narang ◽  
Ian Reid
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Vitamin D Deficiency ◽  
Laboratory Tests ◽  
Calcium Supplementation ◽  
Pharmacological Management ◽  
Hydroxyvitamin D ◽  
Complete Reversal ◽  
Mri Scans ◽  
25 Hydroxyvitamin D

A 56-year-old man was referred with left-sided hip pain. MRI scans demonstrated an undisplaced stress fracture in the femoral neck and subchondral oedema within the femoral head. Bone densitometry showed T-scores of −2.0 at the spine, −3.5 at the femoral neck and −2.4 for the total hip. Laboratory tests revealed 25-hydroxyvitamin D <10 nmol/L. He was prescribed a 10-day course of calciferol 1.25 mg (50 000 IU)/day and started on calcium carbonate 1.25 g twice daily. Following the correction of vitamin D deficiency, his symptoms resolved. A striking feature of this patient was the complete reversal of ‘osteoporosis’ within 14 months with vitamin D and calcium supplementation. Bone mineral densities (BMDs) increased by 19.5% and 33.4% at the spine and hip, respectively. Such changes are never seen with conventional pharmacological management of osteoporosis. Vitamin D deficiency should be considered as a cause for reduced BMD in people with risk factors.

scholarly journals Paradoxical deterioration in seizure control due to anticonvulsant-induced hypocalcaemia

2019 ◽  
Vol 12 (12) ◽  
pp. e232429 ◽  
Author(s):  
Zachary Gauci ◽  
Christopher Rizzo ◽  
Simon Mifsud ◽  
Mario J Cachia
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Calcium Supplementation ◽  
Cytochrome P450 Enzyme ◽  
Hydroxyvitamin D ◽  
P450 Enzyme ◽  
History Of ◽  
25 Hydroxyvitamin D ◽  
History Of Epilepsy ◽  
Hepatic Cytochrome

Hepatic cytochrome P450 enzyme induction is associated with certain antiepileptic drugs (AEDs) and may result in hypocalcaemia secondary to vitamin D deficiency. We report a case of a 44-year-old man with a history of epilepsy, who presented with breakthrough seizures after having previously been seizure-free for 11 years. Investigations revealed severe hypocalcaemia with a corrected calcium of 1.7 mmol/L. His phenytoin dose was increased, and he was started on calcium supplementation. He was discharged with a corrected calcium level of 2.05 mmol/L but was readmitted 1 week later with further seizures and a corrected calcium of 1.89 mmol/L. 25-hydroxyvitamin D was low. AED-induced hypocalcaemia was suspected, which had been made paradoxically worse by the increase in phenytoin dose. Alfacalcidol was prescribed and he was switched from phenytoin to levetiracetam with resolution of hypocalcaemia and no further seizures. The authors recommend screening for calcium and vitamin D deficiency in patients on enzyme-inducing AEDs.

scholarly journals Combined vitamin D and calcium supplementation in vitamin D inadequate patients with urolithiasis: Impact on hypercalciuria and de novo stone formation

2015 ◽  
Vol 9 (11-12) ◽  
pp. 403 ◽  
Author(s):  
Charles Hesswani ◽  
Yasser A Noureldin ◽  
Mohamed A Elkoushy ◽  
Sero Andonian
Keyword(s):  
Vitamin D ◽  
De Novo ◽  
Stone Formation ◽  
Calcium Supplementation ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Hydroxyvitamin D ◽  
History Of ◽  
25 Hydroxyvitamin D

<p><strong>ABSTRACT </strong></p><p><strong>Introduction</strong>: We examined the effect of combined vitamin D and calcium supplementation (VDCS) on urinary calcium excretion and de novo stone formation in vitamin D inadequate (VDI) urolithiasis patients.</p><p><strong>Methods</strong>: We retrospectively reviewed the data of VDI patients (serum 25-hydroxyvitamin D&lt;75 nmol/L) followed at a tertiary stone centre between September 2009 and December 2014. VDI patients with history of urolithiasis, who were placed on VDCS for abnormal bone mineral density or hyperoxaliuria, were included. Hypercalciuric patients and patients on thiazide diuretics were excluded. Metabolic stone workup and two 24-hour urine collections were performed before and after VDCS.</p><p><strong> Results</strong>: In total, we inculded 34 patients, with a mean age of 54.8 years and a mean body mass index of 25.7 kg/m2. After VDCS, there was a significant increase in the mean serum 25-hydroxyvitamin D (52.0 vs. 66.4 nmol/L, p&lt;0.001) and the mean urinary calcium excretion (3.80 vs. 5.64 mmol/d, p&lt;0.001). Eight (23.5%) patients developed de novo hypercalciuria. After a median follow-up of 39 (range: 7-60) months, 50% of hypercalciuric patients developed stones compared with 11.5% of non-hypercalciuric patients (p=0.038).</p><p><strong>Conclusion</strong>: This study showed a significant effect of combined VDCS on mean urinary calcium excretion, de novo hypercalciuria, and stone development in VDI patients with history of urolithiasis. Therefore, VDI urolithiasis patients receiving VDCS are advised to have monitoring with 24-hour urine collections and imaging studies. Although small, the sample size is good enough to validate the statistical outcomes. Prospective studies are needed to confirm these results.</p>

scholarly journals Effect of vitamin D supplementation, directly or via breast milk for term infants, on serum 25 hydroxyvitamin D and related biochemistry, and propensity to infection: a randomised placebo-controlled trial

2016 ◽  
Vol 116 (1) ◽  
pp. 52-58 ◽  
Author(s):  
David D. Chandy ◽  
Jahnavi Kare ◽  
Shakal N. Singh ◽  
Anjoo Agarwal ◽  
Vinita Das ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Controlled Trial ◽  
Sun Exposure ◽  
Vitamin D Supplementation ◽  
Elevated Alkaline Phosphatase ◽  
Hydroxyvitamin D ◽  
Group A ◽  
25 Hydroxyvitamin D ◽  
Group B

AbstractWe assessed the effect of vitamin D supplementation on related biochemistry, infection and dentition of the infant. In a double-blind, placebo-controlled trial conducted in Lucknow, India (latitude 26°N), 230 mother –newborn pairs were randomised to receive, for 9 months, 3000µg/month oral vitamin D3 by the mother (group A) or 10µg/d by the infant (group B) or double placebo (group C). All babies received 15 min of sun exposure (unclothed) during massage. Infants’ median 25-hydroxyvitamin D (25(OH)D) was lower in group C (median 45·3; interquartile range (IQR) 22–59·5 nmol/l) than in groups A (median 60·8; IQR 41·3–80·5 nmol/l (P<0·01)) and B (median 61·3; IQR 41·3–75·3 nmol/l (P<0·05)) at 3·5 months. Infant 25(OH)D correlated negatively with infant parathyroid hormone (r −0·46, P<0·01). Elevated alkaline phosphatase (>7.5µkat/l) was significantly more frequent in group C babies (16 %) than in group A (4 %) or group B (0 %) babies. The number of days with respiratory or diarrhoeal infection by 9 months of age was higher in group C (median 46·5; IQR 14·8–73·3 d) than in group A (median 18·5; IQR 8·8–31·0 d (P<0·01)) or group B (median 13·0; IQR 7·0–28·5 (P<0·05)). We conclude that monthly maternal or daily infant supplementation with vitamin D along with sun exposure is superior to sun exposure alone in maintaining normal infant 25(OH)D at 3·5 months, and provide protection from elevated alkaline phosphatase and infectious morbidity.

Importance of Vitamin D and Calcium at Older Age

2008 ◽  
Vol 78 (6) ◽  
pp. 286-292 ◽  
Author(s):  
Heike A. Bischoff-Ferrari ◽  
Hannes B. Staehelin
Keyword(s):  
Vitamin D ◽  
Dairy Products ◽  
Calcium Supplementation ◽  
Fracture Prevention ◽  
Controlled Trials ◽  
Hydroxyvitamin D ◽  
Randomized Controlled ◽  
25 Hydroxyvitamin D ◽  
Muscle Health ◽  
Vitamin D Supplement

We review the potential of vitamin D for the prevention of falls and fractures. Evidence from randomized-controlled trials will be reviewed for both endpoints, as well as epidemiologic data that correlates higher 25-hydroxyvitamin D status with better bone and muscle health. This review summarizes the compelling dual benefit of vitamin D on bone and muscle health, a concept that is unique and important for optimal fracture prevention at higher age. We will review sources of vitamin D and calcium and also outline why calcium supplementation alone may not contribute to fracture prevention at higher age. This review concludes that vitamin D at a dose of at least 800 IU per day should be provided to all postmenopausal women and everybody starting at age 60 for optimal bone and muscle health. In combination with a vitamin D supplement, dairy products may be an optimal source of calcium at higher age as milk provides both calcium and protein.

scholarly journals D-vitamin és kalcium a klinikai evidenciák tükrében

2016 ◽  
Vol 157 (31) ◽  
pp. 1242-1247
Author(s):  
László Bajnok
Keyword(s):  
Vitamin D ◽  
Calcium Supplementation ◽  
Vitamin D Supplementation ◽  
Biological Mechanisms ◽  
Optimal Range ◽  
Hydroxyvitamin D ◽  
J Curve ◽  
25 Hydroxyvitamin D ◽  
Neutral Effect ◽  
The Ideal

The biological mechanisms, ecological and observational studies indicate increased morbidity and mortality in vitamin D deficiency, while the controlled, randomized supplementation trials – carried out mostly in vitamin D deficient patients – have shown no or some marginal benefits, mostly in preventing institutionalized elderly individuals’ falls and fractures. Clarity is also disturbed by that the primary end points of intervention studies were generally not extraskeletal. The ideal serum 25-hydroxyvitamin D levels also considerably controversial: there is clearly a J-curve, but the optimal range is uncertain. All of these uncertainties appear also in the vitamin D guidelines which are, however, concordant in that they do not recommend (i) a population-wide screening and (ii) vitamin D supplementation with extraskeletal aim – beyond the prevention of falls. Certain studies suggest that calcium supplementation increases the incidence of cardiovascular events, while others show a neutral effect in this respect. There are several ongoing vitamin D studies directly designed for extraskeletal events. Orv. Hetil., 2016, 157(31), 1242–1247.

Depressed Serum 25-Hydroxyvitamin D Levels Increase Hospital Stay and Alter Glucose Homeostasis in First-ever Ischemic Stroke

2019 ◽  
Vol 16 (4) ◽  
pp. 340-347
Author(s):  
Yuge Wang ◽  
Yanqiang Wang ◽  
Bingjun Zhang ◽  
Yinyao Lin ◽  
Sha Tan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Ischemic Stroke ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Vitamin D Deficiency ◽  
Glucose Homeostasis ◽  
Clinical Severity ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D ◽  
Deficiency Group

Background and Objective: Vitamin D deficiency is internationally recognized among the potentially modifiable risk factors for ischemic cardio-cerebrovascular diseases. However, the association between vitamin D deficiency and stroke morbidity or mortality remains insufficiently known. Our aim is to investigate their relevance to 25-hydroxyvitamin D [25(OH) D] levels and clinical severity and outcome after 3 months in first-ever ischemic stroke. Methods: Retrospective analysis of 356 consecutive patients in first-ever ischemic stroke between 2013 and 2015. Serum 25(OH) D levels were measured at baseline. Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS) score. Functional outcome after 3 months of onset was evaluated using the modified Rankin scale (mRS). Results: Among the 356 enrolled patients, HbA1c was higher in insufficiency/deficiency group than that in the sufficiency group (6.3 ± 1.7 vs. 5.9 ± 1.1, p =0.015). The hospital stay was longer in insufficiency/deficiency group than that in the sufficiency group (11 (8-17) vs. 9.5 (7-13), p = 0.035). There was a significant inversed trend between serum 25(OH) D levels and hospital stay (OR 0.960, P = 0.031), using logistic regression. Conclusions: 25(OH)D levels are associated with glucose homeostasis, 25(OH) D contributes to increase the length of hospital stay. Low serum 25-OHD level is an independent predictor for hospital stay in first-ever ischemic stroke. Vitamin D deficiency did not predict functional outcome in the span of 3 months.

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