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Nutritional rickets is increasingly diagnosed in children of ethnic origin
  1. E Odeka,
  2. J Tan
  1. Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, UK; egwareaol.com

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We noted with interest the article published by Ladhani and colleagues1 highlighting the problem of vitamin D deficiency. We agree that this remains a problem, especially in “at risk” ethnic minority groups.

In Oldham, which has a population of 49 992 children, 20.8% are Asians (Census 2001). Between December 2002 and March 2004, we identified nine cases of hypocalcaemia/rickets secondary to vitamin D deficiency. We excluded those with vitamin D deficiency secondary to other conditions of non-nutritional aetiologies. All of the nine children had biochemical changes of raised alkaline phosphatase and levels of 25-OHD below 10 ng/ml; three had radiological evidence of rickets. Eight were of Asian origin and five were male.

Presentation of these children was divided into those with hypocalcaemic symptoms and those with clinical rickets. Six of them presented with hypocalcaemic symptoms and their ages ranged from 6 days to 13 years of age. These included two neonates who presented with focal seizures; two toddlers under 2 years who presented with generalised seizures; and two 13 year olds who presented with cramps/carpopedal spasms. Three of the nine presented with signs of rickets and were aged 15–19 months.

The two neonates involved were born at term with their birth weights on the 25th centiles. Calcium levels were 1.39 and 1.54 mmol/l respectively. Both were on formula feeds, and tests on maternal blood revealed levels of parathyroid hormone and calcium suggestive of vitamin D deficiency. Four toddlers were still breast fed, all of whom were confirmed from dietary history to have limited solid intake. Of the two teenagers, one had a diet low in calcium and the other had background problems of abdominal pain.

All the children were treated with vitamin D, and three children also received oral calcium supplements. All responded to treatment with normalisation of biochemical bone profiles and vitamin D/parathyroid hormone levels.

There is no information on the prevalence of rickets in the UK; however, there are reports to say that this is growing.2 Our experience and reports across the UK show that the ethnic minority population still remains at risk of vitamin D deficiency. Efforts to promote vitamin D supplementation as recommended by the Department of Health3 need to be implemented and targeted at the risk group.

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