The re-emerging burden of rickets: a decade of experience from Sydney

Robinson, Paul D.; Högler, Wolfgang; Craig, Maria E.; Verge, CF; Walker, Judith S.; Piper, A C; Woodhead, Helen; Cowell, Chris; Ambler, Geoffrey

doi:10.1136/adc.2004.069575

Cited by 178 publications

(153 citation statements)

References 33 publications

(29 reference statements)

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“…Several studies have suggested a secular increase in the absolute numbers of children presenting with symptomatic VDD [3,5,7,6,109,4], but few of these report actual incidence rates [5,7]. As such, temporal changes in population size might be contributing to the observed increases.…”

Section: Discussionmentioning

confidence: 97%

“…There is no doubt that severe VDD can lead to symptomatic hypocalcaemia and rickets (for review articles detailing the pathophysiology, clinical and radiological features of rickets see [10][11][12]18,19]). However, although there has been a suggestion that cases of rickets are increasing in many developed countries, including the UK [3], Australia [4], the USA [6,5] and Denmark [7], overt rickets remains uncommon. Surveys in the UK, Canada and Australia have reported the incidence of symptomatic VDD (radiographic rickets or hypocalcaemic seizures due to VDD) to be between 2.9 and 7.5 per 100,000 children [20][21][22], but VDD rickets is rare in white Caucasian children and the majority of cases are reported in children of African and Asian ethnicity [3,4,20,21]; a 2001 survey of VDD rickets in children aged less than 5 years in the West Midlands, UK, estimated the incidence in Caucasian children to be 0.4 per 100,000 compared with 38 per 100,000 in Asian children and 95 per 100,000 in children of Black-African or Afro-Caribbean ethnicity [20].…”

Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

“…Fracture can be the presenting feature of VDD rickets [3,4,6,22,[43][44][45][46][47][48][49]. However it is relatively uncommon.…”

Section: Fracture In Children With Vitamin D Deficiency Ricketsmentioning

confidence: 99%

“…However, in recent years there has been increasing interest in the contribution of vitamin D to other aspects of bone health, including fracture risk and bone mineral density (BMD). Concurrently there has been an increase in the screening for biochemical VDD [1,2], and a suggested re-emergence of both VDD and rickets in many developed countries [3][4][5][6][7]. In older adults, VDD has been associated with increased fracture risk and there is some evidence that vitamin D (in combination with calcium) supplementation can reduce this [8].…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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Section: Discussionmentioning

confidence: 97%

Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

“…Fracture can be the presenting feature of VDD rickets [3,4,6,22,[43][44][45][46][47][48][49]. However it is relatively uncommon.…”

Section: Fracture In Children With Vitamin D Deficiency Ricketsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vitamin D and skeletal health in infancy and childhood

et al. 2014

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“…According to the Australian researchers, moderate (12.5-25 nmol/l) and severe (calcidiol level below 12.5 nmol/l) deficiencies were observed in more than 70% of the children with rickets and 90% of the children with hypocalcaemia. Signs of rickets were observed in 86% of the children with the calcidiol level < 20 nmol/l (8 ng/ml); hypocalcaemia was observed in 94% thereof [19]. The calcidiol level in most people living in the equatorial latitudes exceeds 30 ng/ml.…”

mentioning

confidence: 94%