ICCBH2019 Poster Presentations (1) (226 abstracts)
Vitamin D deficiency nutritional rickets presenting to secondary care in children (<16 Years) – A United Kingdom surveillance study
Nick Shaw 1 , Zulf Mughal 2 , Priscilla Julies 3 , Karina Pall 4 , Richard Lynn 4 , Marina Leoni 4 , Alistair Calder 5 , Ciara McDonnell 6 , Helen McDevitt 7 & Mitch Blair 8
1Birmingham Children’s Hospital, Birmingham, UK; 2Royal Manchester Children’s Hospital, Manchester, UK; 3Royal Free London NHS Foundation Trust, London, UK; 4Royal College of Paediatrics & Child Health, London, UK; 5Great Ormond Street Hospital, London, UK; 6Temple Street Children’s Hospital, Dublin, Ireland; 7Royal Hospital for Sick Children, Glasgow, UK; 8Northwick Park Hospital, London, UK.
Objectives: Nutritional Rickets (NR) is the commonest cause of rickets worldwide. Although the prevalence of rickets has been widely reported to be increasing, the actual national incidence of NR in the United Kingdom (UK) is unknown.
Methods: Retrospective data were collected monthly between March 2015 and March 2017 from 3500 consultant paediatricians using British Paediatric Surveillance Unit (BPSU) reporting methodology. Clinicians completed an online clinical questionnaire for cases fitting the case definition which were: a) Clinical Rickets – Leg deformity/swollen wrists, knees or ribs and 25OH Vitamin D < 25 nmol/l with one or more abnormalities of serum calcium, alkaline phosphatase, phosphate or parathyroid hormone OR b) Radiological rickets: Widening, cupping, splaying of metaphysis (of any long bone) and 25OH Vitamin D <25 nmol/l.
Results: One hundred and twenty-five cases met the case definition, an annual incidence of 0.48 (95% CI 0.37 to 0.62) per 100,000 children under 16 years. 116 children were under five years, an annual incidence of 1•39 (95% CI 1.05 to 1.81) per 100,000. Boys (70%) were significantly more affected than girls (30%) (OR 2.17, 95% CI 1.25 to 3.78, P=0.005) and the majority were of Black (43%) or South Asian ethnicity (38%). The median age at diagnosis was 18 months. 77.6% of children were not taking vitamin D supplements. Complications included delayed gross motor development (26.4%), fractures (9.6%), hypocalcaemic seizures (8%) and 4 cases of dilated cardiomyopathy (3%) of whom 2 died (1.6%). In a further 8 cases, rickets was confirmed but excluded from the incidence analysis, as not meeting the case definition of a 25OH vitamin D <25 nmol/L.
Conclusion: The incidence of VDD NR in the UK is lower than previously thought. Serious complications and unexpected deaths, particularly in Black and South Asian children under five years have occurred. Both VDD and dietary calcium deficiency are playing a role in its pathogenesis. Uptake of vitamin D supplementation remains low and constitutes a failure of current public health policy. A UK national policy focusing on vitamin D supplementation, dietary calcium intake and adherence is required to eliminate this entirely preventable condition.
Disclosure: The authors declared no competing interests.
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