The role of risk factors in child rickets

Authors: Cosmin OpreaCoauthors: Maria Oana Mărginean, Răzvan Mareș, Cristina Câmpean

Coordinator: Prof. Cristina Oana Mărginean

Introduction

Rickets

• An osteodistrophy deficiency, characterised by an inadequate mineralization of the bone osteoid

• A disease of the growing bone, occurs before the fusion of the epiphyses, unlike osteomalacia, which affects bones which do not grow

• Growth plate continues to expand, but mineralization does not occur → growth plate tickens → bone diformities

• Etiology: vitamin D (most often), Ca or P defficiency

Background

Decisive factors in the development of rickets

• Vitamin D defficiency: insufficient intake or insufficient cutaneous synthesis

• Lack of exposure to the sun: limits cutaneous synthesis of vitamin D

• The homeostasis of Ca and P : vitamin D plays a major role in the intestinal absorption of Ca and P

• Other processes which are affected by vitamin D:

muscular ATP synthesisiron absorptionmetabolic processes

BackgroundRisk factors in rickets

small age ( from 3 months up to 2 years) rapid growth nutritional factors- inadequate diets:

life conditions

pigmentation

artificial nutrition (cow milk) dairy products which lack sufficient vitamin D vegan diet food rich in flour, oxalates, P total parenteral nutrition

temperate climate poluted environment sun exposure

Background

Risk factors in rickets

conditions which prevent hydroxilation (hepatic, renal) conditions which prevent intestinal absorption (cystic

fibrosis, celiac disease) medicines:

maternal factor:

cortisone anticonvulsivants iron heparin chelating agents

exposure to sun rickets prophilaxy

Background

Clinical manifestations of rickets

• Debut- unspecific symptons: irascibility anxiety capricious apetite agitation sweat reduced sleep

Background

Clinical manifestations of rickets

• State period- specific symptoms: Craniotabes: parietal and occipital softening,“ping-pong” ball sensation Teeth: tardive eruption, hypoplasia, dental caries Head and Forehead: high forehead, brachicephaly, plagicephaly, delayed fontanelle

closure, frontal bossing, craniosynosthosis Thorax: deformations, rachitic rosary, Harrison groove Spine: scoliosis, kyphosis, lordosis Upper limbs: “rachitic bracelets”, enlargement of the wrists Lower limbs: varum or valgum diphormities Hypocalcemic symptoms: tetany, seizures, laryngeal spasm

Objective

The objective of this study was to assess whether the most frequent risk factors known to be involved in the pathogenesis of rickets are positively correlated with different manifestations of the disease in the patients included in this study. 

Material and methods• Prospective study conducted on 66 hospitalised

children admited in the Pediatrics Clinic I, in the period November 2014- March 2015

• Questionnaires which were filled in by their mothers• Questions related to the main predisposing factors

involved in the development of rickets, including: alimentation aspects, sun exposure, life conditions, the presence of other related diseases, medication, maternal factor, vitamin D prophylaxis and the patients’ birth and development aspects

Material and methods

Material and methods

Material and methods

• Inclusion criteria: control group–hospitalised children without any

manifestations of the disease study group- hospitalised children with skeletal and

subclinical manifestations of the disease

• Exclusion criteria: children with hematologic or oncologic diseases children with genetic syndromes

•

Results

• Sex and age distributionControl group Study group

Mean age 17,03 months 8,05 months

Results- risk factors

p= 0,048OR=3,2

Results- risk factors

p= 0,03OR=3,4

Results- risk factors

p<0,01OR=6,2

Results-risk factors

Study group

Control group

Poluted environment 18 14 P=0,32

No polution 14 20 OR=1,83

Study group Control group

Urban 16 17 P=1,19

Rural 16 17 OR=1

Skeletal manifestations

Control group

Child profilaxy 17 27 P= 0,46

No child profilaxy 2 7 OR=2,2

Results-risk factorsStudy group Control group

Intense pigmentation 5 11 P=0,15

Normal pigmentation 27 23 OR=0,38

Study group Control group

Mature at birth 19 24 P=0,43

Premature 13 10 OR=0,6

Skeletal manifestations

Control group

Breast fed min 6 months 12 14 P=0,15

Breast fed for less than 6 months

17 8 OR=0,4

Results- symptoms

p< 0,01OR=6,42

Results-symptoms

p<0,01OR=7,23

Conclusions• The main risk factors which were linked in our study with

the pathogenesis of the disease included:– cereals consumption, – low exposure to the sun, – anemia and male sex.

• A late closure of the fontanella is significantly correlated with the development of the disease

• There is also a positive correlation between neck sweats and skeletal manifestations of the disease

• With proper and early prophilaxy, the incidence of rickets can be drastically decreased

• By continuing the screening on additional cases, the role of the main risk factors could be further determined

Thank you for your attention!