J Korean Orthop Assoc.  2011 Oct;46(5):431-437.

Four Cases of Vitamin D Deficiency Rickets with Lower Extremity Deformities

• Cha SM
• Shin HD
• Kim KC

Abstract

Since the overall nutritional status of the general population has improved nowadays and manufactured formulas contain vitamin D, the prevalence of vitamin D deficiency rickets has significantly decreased. Recently, however, 4 cases with lower extremity deformities came to the outpatient department. Among them, 1 case consumed only Sunsik (a powder mixture of several grains and fruits) instead of the manufactured formula, to control atopic dermatitis, 2 cases stopped eating due to diarrhea from milk feeds, and to control atopic dermatitis. 1 case was on a normal diet without any specific allergic reaction to foods, but had very less exposure to sunlight. Providing sufficient vitamin D and calcium, along with increasing the time of sunlight exposure have significantly improved the hematologic and radiologic findings, and the bone growth. The authors will explain the necessity of adequate supplementation of vitamin D and calcium, especially in cases which control or restrict their diet due to food allergies.

Keyword

growth plate; rickets; vitamin D deficiency

MeSH Terms

Bone Development
Calcium
Edible Grain
Congenital Abnormalities
Dermatitis, Atopic
Diarrhea
Diet
Eating
Food Hypersensitivity
Growth Plate
Humans
Hypersensitivity
Lower Extremity
Milk
Nutritional Status
Outpatients
Porphyrins
Prevalence
Rickets
Sunlight
Vitamin D
Vitamin D Deficiency
Vitamins
Calcium
Porphyrins
Vitamin D
Vitamins

Figure

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  Figure 1 17 month-old male, (A) wrist showed irregular shadow and widening of epiphyseal plate, "cupping", bony shadow of periosteum was found, and also similar lesion was found both right and left. (B) Generally decreased bone shadow, varus of knee and ankle joint, widening and irregularity of epiphyseal plate of distal femur and proximal tibia, and cupping of metaphysis were found. Anterolateral bowing of tibia was symmetrically found. (C, D) On 4 weeks follow up, the radiologic findings showed homogenous decrease of interval of epiphysis, bone shadow of periosteum.

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  Figure 2 19 month-old male, (A) widened epiphyseal plate of distal femur and proximal tibia and cupping of methaphysis was also found. Bowing of tibia was not conspicuous. (B, C) There was no specific radiologic finding of vertebra, pelvis, and hip joint. (D) On 6 months follow up, body weight was 12.4 kg and height was 87.5 cm, and recovered to 40 percentage, and simple radiograph taken on which showed remodeling findings.

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  Figure 3 18 month-old female. (A) Showing genu varum, and also conventional radiologic findings of rickets of distal femur, proximal tibia, and distal tibia. (B) After 6 months of follow up, the gait and frequency of tripping over improved and the findings of epiphyseal fraying and cupping and irregularity of metaphysis were improved and growth status was also improved to 50 percentages.

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  Figure 4 28 month-old male. (A-C) There are irregular shadow and widened epiphyseal plate, and cupping, and bony shadow from periosteum was clearly found. (D-F) On 18 months follow up, body weight is 14.7 kg which is improved to 50 percentages, and radiologic study also showed excellent regeneration of growth plate and metaphysis.

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