Children in Nigeria may develop a nutritional rickets associated with low calcium intake.


In a developing country there may be multiple reasons for dietary rickets and so each cause must be considered (dietary calcium, vitamin D intake, gastrointestinal disease, poor sunlight exposure, etc)..


Clinical features:

(1) evidence of rickets (clinical, radiologic, biochemical)

(2) low to normal serum calcium

(3) low to normal serum phosphate

(4) normal serum 25-hydroxyvitamin D

(5) positive clinical response to calcium supplementation

(6) absence of alternative explanations



• A low serum 25-hydroxyvitamin D may reflect concomitant vitamin D deficiency.

• An elevated serum alkaline phosphatase for age was used as biochemical evidence of rickets.


Criteria for response to calcium supplementation:

(1) radiographic correction of bone deformities after 3 months

(2) decrease in serum alkaline phosphatase levels to the age-related reference range

(3) normal serum calcium


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