Rare Nutritional Rickets increased 10X in 20 years – Feb 2013

Increasing incidence of nutritional rickets: a population-based study in olmsted county, Minnesota.

Mayo Clin Proc. 2013 Feb;88(2):176-83. doi: 10.1016/j.mayocp.2012.10.018.
Thacher TD, Fischer PR, Tebben PJ, Singh RJ, Cha SS, Maxson JA, Yawn BP.
Department of Family Medicine, Mayo Clinic, Rochester, MN. Electronic address: thacher.thomas at mayo.edu.

OBJECTIVE: To determine temporal trends in incidence and risk factors of nutritional rickets in a community-based population.

PATIENTS AND METHODS: Rochester Epidemiology Project data were used to identify all children (aged <18 years) residing in Olmsted County, Minnesota, between January 1, 1970, and December 31, 2009, with diagnostic codes corresponding to rickets, vitamin D deficiency, hypovitaminosis D, rachitis, osteomalacia, genu varum, genu valgum, craniotabes, hypocalcemia, hypocalcemic seizure, and tetany. Record abstraction was performed to select individuals with radiographic confirmation of rickets. Age- and sex-matched controls were identified for the evaluation of risk factors. The main outcome measure was radiographic evidence of rickets without identifiable inherited, genetic, or nonnutritional causes. Incidence rates were calculated using Rochester Epidemiology Project census data.

RESULTS: Of 768 children with eligible diagnostic codes, 23 had radiographic evidence of rickets; of these, 17 children had nutritional rickets. All 17 children were younger than 3 years, and 13 (76%) were of nonwhite race/ethnicity. Clinical presentation included poor growth (n=12), leg deformity (n=8), motor delay (n=5), leg pain (n=3), weakness (n=3), and hypocalcemia or tetany (n=2). The incidence of nutritional rickets in children younger than 3 years was 0, 2.2, 3.7, and 24.1 per 100,000 for the decades beginning in 1970, 1980, 1990, and 2000, respectively (P=.003 for incidence trend). Nutritional rickets was associated with black race, breast-feeding, low birth weight, and stunted growth (P<.05 for all). Four of 13 patients (31%) who underwent 25-hydroxyvitamin D testing had values less than 10 ng/mL.

CONCLUSION: Nutritional rickets remains rare, but its incidence has dramatically increased since 2000. Not all cases of rickets can be attributed to vitamin D deficiency.

Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

PMID: 23374621

It appears that Nutritional Rickets is associated with some combination of low Calcium, Phosphorus, as well as low vitamin D

See also VitaminDWiki

• All items in category Rickets and vitamin D 127 items
• Overview of Rickets and Vitamin D
• Giving vitamin D to ALL children reduced (rickets) symptoms by 60 percent – Aug 2012
• Rickets increasing in dogs
• Dark Skinned babies probably need vitamin D to prevent nutritional rickets - 2001
• Nutritional Rickets in Denmark especially among immigrant children- Feb 2012 PhD dissertation, had the following chart
  Criteria for deciding type of rickets

See also web

• Nutritional rickets around the world Dec 2012, Special Issue – Vitamin D Workshop