Top

European Journal of Pediatrics

Published in:

01-08-2009 | Original Paper

Nutritional rickets in Denmark: a retrospective review of children’s medical records from 1985 to 2005

Authors: Signe Sparre Beck-Nielsen, Tina Kold Jensen, Jeppe Gram, Kim Brixen, Bendt Brock-Jacobsen

Published in: European Journal of Pediatrics | Issue 8/2009

Abstract

Introduction

This study describes clinical and biochemical characteristics of nutritional rickets and risk factors at diagnosis among children living in Denmark. All medical records from patients with rickets referred to or discharged from hospitals in Southern Denmark from 1985 to 2005 were identified by register search.

Materials and methods

Patients included were younger than 15 years of age and fulfilled the diagnostic criteria of primary, nutritional rickets. A total of 112 patients with nutritional rickets were included: 29 were of ethnic Danish origin, and 83 were immigrants.

Results

Patients diagnosed before the age of 4 (median 1.4) years displayed the classic clinical signs of rickets, whereas patients diagnosed after the age of 4 (median 12.5) years had few clinical signs and unspecific symptoms. Ethnic Danish patients were only diagnosed before age 24 months, and they accounted for 73% of all cases presenting with hypocalcemic seizures, but biochemically, they did not have more severe rickets. Of patients diagnosed before the age of 4 years, 45% were ethnic Danish. In early childhood, insufficient or no vitamin D supplementation was given in 88% of all cases. Among immigrant girls older than 4 years of age, 78% were veiled.

Discussion

Nutritional rickets in Denmark is predominantly a disease among immigrants, but ethnic Danish patients comprised nearly half of all patients diagnosed before the age of 4 years, and they presented more frequently with hypocalcemic seizures. The main risk factors were omitted, such as vitamin D prophylaxis among the youngest patients and veiling among older children/teenagers.

Al-Mustafa ZH, Al-Madan M, Al-Majid HJ et al (2007) Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Ann Trop Paediatr 27(1):63–67PubMedCrossRef

Andersen E, Hutchings B, Jansen J et al (1982) Heights and weights of Danish children. Ugeskr Laeger 144(24):1760–1765PubMed

Andersen R, Molgaard C, Skovgaard LT et al (2008) Pakistani immigrant children and adults in Denmark have severely low vitamin D status. Eur J Clin Nutr 62(5):625–634PubMedCrossRef

Andiran N, Yordam N, Ozon A (2002) Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 18(1):47–50PubMedCrossRef

Ashraf A, Mick G, Atchison J et al (2006) Prevalence of hypovitaminosis D in early infantile hypocalcemia. J Pediatr Endocrinol Metab 19(8):1025–1031PubMed

Balasubramanian S, Shivbalan S, Kumar PS (2006) Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants. Indian Pediatr 43(3):247–251PubMed

Belachew T, Nida H, Getaneh T et al (2005) Calcium deficiency and causation of rickets in Ethiopian children. East Afr Med J 82(3):153–159PubMed

Blok BH, Grant CC, McNeil AR et al (2000) Characteristics of children with florid vitamin D deficient rickets in the Auckland region in 1998. N Z Med J 113(1117):374–376PubMed

Bodnar LM, Simhan HN, Powers RW et al (2007) High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 137(2):447–452PubMed

10.

Brot C, Vestergaard P, Kolthoff N et al (2001) Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr 86 Suppl 1:S97–103

11.

Callaghan AL, Moy RJ, Booth IW et al (2006) Incidence of symptomatic vitamin D deficiency. Arch Dis Child 91(7):606–607PubMedCrossRef

12.

Dahifar H, Faraji A, Yassobi S et al (2007) Asymptomatic rickets in adolescent girls. Indian J Pediatr 74(6):571–575PubMedCrossRef

13.

Dawodu A, Agarwal M, Sankarankutty M et al (2005) Higher prevalence of vitamin D deficiency in mothers of rachitic than nonrachitic children. J Pediatr 147(1):109–111PubMedCrossRef

14.

DeLucia MC, Mitnick ME, Carpenter TO (2003) Nutritional rickets with normal circulating 25-hydroxyvitamin D: a call for reexamining the role of dietary calcium intake in North American infants. J Clin Endocrinol Metab 88(8):3539–3545PubMedCrossRef

15.

Hochberg Z (2003) Rickets—past and present. Introduction. Endocr Dev 6:1–13PubMedCrossRef

16.

Holick MF (2006) Resurrection of vitamin D deficiency and rickets. J Clin Invest 116(8):2062–2072PubMedCrossRef

17.

Kreiter SR, Schwartz RP, Kirkman HN Jr. et al (2000) Nutritional rickets in African American breast-fed infants. J Pediatr 137(2):153–157PubMedCrossRef

18.

Ladhani S, Srinivasan L, Buchanan C et al (2004) Presentation of vitamin D deficiency. Arch Dis Child 89(8):781–784PubMedCrossRef

19.

Lazol JP, Cakan N, Kamat D (2008) 10-Year case review of nutritional rickets in Children’s Hospital of Michigan. Clin Pediatr (Phila) 47(4):379–384

20.

Lips P (2004) Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol 89–90(1–5):611–614PubMedCrossRef

21.

Lips P (2007) Relative value of 25(OH)D and 1,25(OH)2D measurements. J Bone Miner Res 22(11):1668–1671PubMedCrossRef

22.

Lulseged S, Fitwi G (1999) Vitamin D deficiency rickets: socio-demographic and clinical risk factors in children seen at a referral hospital in Addis Ababa. East Afr Med J 76(8):457–461PubMed

23.

Mughal Z (2002) Rickets in childhood. Semin Musculoskelet Radiol 6(3):183–190PubMedCrossRef

24.

Narchi H, El JM, Kulaylat N (2001) Symptomatic rickets in adolescence. Arch Dis Child 84(6):501–503PubMedCrossRef

25.

Pedersen P, Michaelsen KF, Molgaard C (2003) Children with nutritional rickets referred to hospitals in Copenhagen during a 10-year period. Acta Paediatr 92(1):87–90PubMed

26.

Ramavat LG (1999) Vitamin D deficiency rickets at birth in Kuwait. Indian J Pediatr 66(1):37–43PubMedCrossRef

27.

Robinson PD, Hogler W, Craig ME et al (2006) The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child 91(7):564–568PubMedCrossRef

28.

Salimpour R (1975) Rickets in Tehran. Study of 200 cases. Arch Dis Child 50(1):63–66PubMedCrossRef

29.

Shah M, Salhab N, Patterson D et al (2000) Nutritional rickets still afflict children in north Texas. Tex Med 96(6):64–68PubMed

30.

Shaikh U, Alpert PT (2006) Nutritional rickets in Las Vegas, Nevada. J Pediatr Endocrinol Metab 19(3):209–212PubMed

31.

Shaw NJ (2003) Vitamin D deficiency rickets. Endocr Dev 6:93–104PubMedCrossRef

32.

Siddiqui TS, Rai MI (2005) Presentation and predisposing factors of nutritional rickets in children of Hazara Division. J Ayub Med Coll Abbottabad 17(3):29–32PubMed

33.

Wagner CL, Hulsey TC, Fanning D et al (2006) High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med 1(2):59–70PubMedCrossRef

34.

Ward LM, Gaboury I, Ladhani M et al (2007) Vitamin D-deficiency rickets among children in Canada. CMAJ 177(2):161–166PubMed

35.

Webb AR (2006) Who, what, where and when—influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92(1):17–25PubMedCrossRef

36.

Weisberg P, Scanlon KS, Li R et al (2004) Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr 80(6 Suppl):1697S–1705SPubMed

37.

Wikland KA, Luo ZC, Niklasson A et al (2002) Swedish population-based longitudinal reference values from birth to 18 years of age for height, weight and head circumference. Acta Paediatr 91(7):739–754PubMedCrossRef

38.

Wondale Y, Shiferaw F, Lulseged S (2005) A systematic review of nutritional rickets in Ethiopia: status and prospects. Ethiop Med J 43(3):203–210PubMed

Title: Nutritional rickets in Denmark: a retrospective review of children’s medical records from 1985 to 2005
Authors: Signe Sparre Beck-Nielsen
Tina Kold Jensen
Jeppe Gram
Kim Brixen
Bendt Brock-Jacobsen
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: European Journal of Pediatrics / Issue 8/2009
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-008-0864-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nutritional rickets in Denmark: a retrospective review of children’s medical records from 1985 to 2005

Abstract

Introduction

Materials and methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 8/2009

Noonan syndrome caused by germline KRAS mutation in Taiwan: report of two patients and a review of the literature

Hospital admission in children up to the age of 2 years

Policies and practices for the clinical management of HIV/HCV coinfected children in Europe: an epidemiological survey

Hamartomas of the oro- and nasopharyngeal cavity in infancy: two cases and a short review

Restrictive dermopathy—a lethal congenital laminopathy. Case report and review of the literature

Effect of variation in RANTES promoter on serum RANTES levels and risk of recurrent wheezing after RSV bronchiolitis in children from Han, Southern China