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G587 How relevant are low levels of vitamin D to radiological skeletal change and a potential risk of fracture: a retrospective study in a tuberculosis clinic
  1. R Raychaudhuri1,
  2. A Demetriou1,
  3. R Bhatt1,
  4. L Jeyalingam1,
  5. G Conder1,
  6. M Pal1,
  7. M Williams2,
  8. C Michie1,
  9. B Williams1,3
  1. 1Paediatrics, London Northwest Healthcare NHS Trust, London, UK
  2. 2Computer Sciences and Clinical Oncology, Imperial NHS Trust, London, UK
  3. 3Royal College of Paediatrics and Child Health, London, UK

Abstract

Background The significance of reduced vitamin D (25-OHD) to skeletal health, as assessed by radiological changes and fracture risk, is not known in detail. The uncertainty of this nutritional interaction becomes critical for instance in cases of potential non-accidental fracture. In order to provide an insight into this area we studied a paediatric group at high risk of low vitamin D levels.

Aims We aimed to estimate the incidence of radiological bony changes in patients attending a paediatric tuberculosis clinic, many of whom have chronically low vitamin D levels. Secondary outcomes were to assess whether serological markers of bone health can be used to identify those at greater risk of osteopenia and rickets.

Methods Children attending a paediatric TB clinic between 01/01/2008 and 31/12/2011 had blood samples, including serum vitamin D levels, and chest radiograph taken as part of routine investigation at diagnosis. All radiographs were reported independently and retrospectively by two consultant radiologists, who were blinded to the child’s vitamin D status, on the presence of osteopenia or rickets.

Results 174 children were included in this study (46.6% male, median age 7 years range, 0.25–16y). At the point of diagnosis, 35 children were 25-OHD deficient (levels <25nmol/l), 57 were insufficient (levels 25–49nmol/l). During the study none of the cases suffered fracture and none had clinical evidence of rickets. Osteopenia was reported in one child by one radiologist. This child had a vitamin D level of 22 nmol/l and a raised PTH at 36.9.

PTH levels were normal in 92 children, unavailable in 45 and raised in 30 children, of whom 29 had normal radiological skeletal appearances. A significant correlation between 25-OHD and PTH was identified (r=–0.371, 95% CI –0.5105 to –0.2123, p value <0.0001). Two children had hypocalcaemia with vitamin D deficiency but had normal PTH and alkaline phosphatase levels. There was no correlation between serum 25-OHD levels and alkaline phosphatase levels.

Conclusion The low incidence of radiographic bony abnormality and absence of fractures in a cohort of children with vitamin D deficiency, suggests many children with low serum vitamin D levels are unlikely to develop rickets and fractures.

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