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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!