Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey.
J Pediatr Endocrinol Metab. 2021 Oct 5;35(2):223-229. doi: 10.1515/jpem-2021-0420. Print 2022 Feb 23.
Nutritional rickets (NR) is still an important problem and one which increasing influxes of immigrants are further exacerbating. This study evaluated cases of mostly immigrant children followed up with diagnoses of NR in our pediatric endocrinology clinic.
Details of 20 cases diagnosed with NR between 2017 and 2020 were retrieved from file records.
Twenty (11 male) cases were included in the study. Three (15%) were Turkish nationals and the others (85%) were immigrants. Hypocalcemia and hypophosphatemia were detected in 17 and 13, respectively. Alkaline phosphatase (ALP) values were normal in two cases, while ALP and parathyroid hormone (PTH) values were elevated in all other cases, and PTH levels were very high (473.64 ± 197.05 pg/mL). 25-hydroxyvitamin D levels were below 20 ng/mL in all cases. Patients with NR received high-dose long-term vitamin D or stoss therapy. Six patients failed to attend long-term follow-up, while PTH and ALP levels and clinical findings improved at long-term follow-up in the other 14 cases.
The elevated PTH levels suggest only the most severe cases of NR presented to our clinic. Clinically evident NR is therefore only the tip of the iceberg, and the true burden of subclinical rickets and osteomalacia remains unidentified. Public health policies should therefore focus on universal vitamin D supplementation and adequate dietary calcium provision, their integration into child surveillance programs, adequate advice and support to ensure normal nutrition, exposure to sunlight, and informing families of the increased risk not only for resident populations but also for refugee and immigrant children.
营养性佝偻病（NR）仍然是一个重要问题，而不断增加的移民涌入使这一问题进一步恶化。本研究评估了我们儿科内分泌科随访诊断为 NR 的主要移民儿童病例。
从档案记录中检索了 2017 年至 2020 年间诊断为 NR 的 20 例病例的详细信息。
研究纳入了 20 例（11 名男性）病例。其中 3 例（15%）为土耳其国民，其余 17 例（85%）为移民。17 例存在低钙血症，13 例存在低磷血症。2 例碱性磷酸酶（ALP）值正常，而所有其他病例的 ALP 和甲状旁腺激素（PTH）值均升高，且 PTH 水平非常高（473.64±197.05 pg/mL）。所有病例的 25-羟维生素 D 水平均低于 20 ng/mL。NR 患者接受了大剂量长期维生素 D 或冲击治疗。6 例患者未能进行长期随访，而其他 14 例患者在长期随访中 PTH 和 ALP 水平及临床症状均有所改善。
升高的 PTH 水平提示只有最严重的 NR 病例才会就诊于我们的诊所。因此，临床上明显的 NR 只是冰山一角，亚临床佝偻病和骨软化症的真实负担仍未确定。公共卫生政策应重点关注普遍补充维生素 D 和充足的膳食钙，将其纳入儿童监测计划，提供充分的建议和支持，以确保正常营养、暴露于阳光，并告知家庭，不仅对居民，而且对难民和移民儿童，风险都会增加。
