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A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children.
N Engl J Med. 1999 Aug 19; 341(8):563-8.NEJM

Abstract

BACKGROUND

Nutritional rickets remains prevalent in many tropical countries despite the fact that such countries have ample sunlight. Some postulate that a deficiency of dietary calcium, rather than vitamin D, is often responsible for rickets after infancy.

METHODS

We enrolled 123 Nigerian children (median age, 46 months) with rickets in a randomized, double-blind, controlled trial of 24 weeks of treatment with vitamin D (600,000 U intramuscularly at enrollment and at 12 weeks), calcium (1000 mg daily), or a combination of vitamin D and calcium. We compared the calcium intake of the children at enrollment with that of control children without rickets who were matched for sex, age, and weight. We measured serum calcium and alkaline phosphatase and used a 10-point radiographic score to assess the response to treatment at 24 weeks.

RESULTS

The daily dietary calcium intake was low in the children with rickets and the control children (median, 203 mg and 196 mg, respectively; P=0.64). Treatment produced a smaller increase in the mean (+/-SD) serum calcium concentration in the vitamin D group (from 7.8+/-0.8 mg per deciliter [2.0+/-0.2 mmol per liter] at base line to 8.3+/-0.7 mg per deciliter [2.1+/-0.2 mmol per liter] at 24 weeks) than in the calcium group (from 7.5+/-0.8 [1.9+/-0.2 mmol per liter] to 9.0+/-0.6 mg per deciliter [2.2+/-0.2 mmol per liter], P<0.001) or the combination-therapy group (from 7.7+/-1.0 [1.9+/-0.25 mmol per liter] to 9.1+/-0.6 mg per deciliter [2.3+/-0.2 mmol per liter], P<0.001). A greater proportion of children in the calcium and combination-therapy groups than in the vitamin D group reached the combined end point of a serum alkaline phosphatase concentration of 350 U per liter or less and radiographic evidence of nearly complete healing of rickets (61 percent, 58 percent, and 19 percent, respectively; P<0.001).

CONCLUSIONS

Nigerian children with rickets have a low intake of calcium and have a better response to treatment with calcium alone or in combination with vitamin D than to treatment with vitamin D alone.

Authors+Show Affiliations

Department of Family Medicine, Jos University Teaching Hospital, Nigeria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10451461

Citation

Thacher, T D., et al. "A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children." The New England Journal of Medicine, vol. 341, no. 8, 1999, pp. 563-8.
Thacher TD, Fischer PR, Pettifor JM, et al. A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. N Engl J Med. 1999;341(8):563-8.
Thacher, T. D., Fischer, P. R., Pettifor, J. M., Lawson, J. O., Isichei, C. O., Reading, J. C., & Chan, G. M. (1999). A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. The New England Journal of Medicine, 341(8), 563-8.
Thacher TD, et al. A Comparison of Calcium, Vitamin D, or Both for Nutritional Rickets in Nigerian Children. N Engl J Med. 1999 Aug 19;341(8):563-8. PubMed PMID: 10451461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of calcium, vitamin D, or both for nutritional rickets in Nigerian children. AU - Thacher,T D, AU - Fischer,P R, AU - Pettifor,J M, AU - Lawson,J O, AU - Isichei,C O, AU - Reading,J C, AU - Chan,G M, PY - 1999/8/19/pubmed PY - 1999/8/19/medline PY - 1999/8/19/entrez KW - Africa KW - Africa South Of The Sahara KW - Age Factors KW - Biology KW - Calcium KW - Child KW - Comparative Studies KW - Deficiency Diseases KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diseases KW - Double-blind Studies KW - English Speaking Africa KW - Food Supplementation KW - Health KW - Health Services KW - Metals KW - Micronutrients KW - Nigeria KW - Nutrition Disorders KW - Nutrition Programs KW - Physiology KW - Population KW - Population Characteristics KW - Primary Health Care KW - Research Methodology KW - Research Report KW - Studies KW - Treatment KW - Vitamins KW - Western Africa KW - Youth SP - 563 EP - 8 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 341 IS - 8 N2 - BACKGROUND: Nutritional rickets remains prevalent in many tropical countries despite the fact that such countries have ample sunlight. Some postulate that a deficiency of dietary calcium, rather than vitamin D, is often responsible for rickets after infancy. METHODS: We enrolled 123 Nigerian children (median age, 46 months) with rickets in a randomized, double-blind, controlled trial of 24 weeks of treatment with vitamin D (600,000 U intramuscularly at enrollment and at 12 weeks), calcium (1000 mg daily), or a combination of vitamin D and calcium. We compared the calcium intake of the children at enrollment with that of control children without rickets who were matched for sex, age, and weight. We measured serum calcium and alkaline phosphatase and used a 10-point radiographic score to assess the response to treatment at 24 weeks. RESULTS: The daily dietary calcium intake was low in the children with rickets and the control children (median, 203 mg and 196 mg, respectively; P=0.64). Treatment produced a smaller increase in the mean (+/-SD) serum calcium concentration in the vitamin D group (from 7.8+/-0.8 mg per deciliter [2.0+/-0.2 mmol per liter] at base line to 8.3+/-0.7 mg per deciliter [2.1+/-0.2 mmol per liter] at 24 weeks) than in the calcium group (from 7.5+/-0.8 [1.9+/-0.2 mmol per liter] to 9.0+/-0.6 mg per deciliter [2.2+/-0.2 mmol per liter], P<0.001) or the combination-therapy group (from 7.7+/-1.0 [1.9+/-0.25 mmol per liter] to 9.1+/-0.6 mg per deciliter [2.3+/-0.2 mmol per liter], P<0.001). A greater proportion of children in the calcium and combination-therapy groups than in the vitamin D group reached the combined end point of a serum alkaline phosphatase concentration of 350 U per liter or less and radiographic evidence of nearly complete healing of rickets (61 percent, 58 percent, and 19 percent, respectively; P<0.001). CONCLUSIONS: Nigerian children with rickets have a low intake of calcium and have a better response to treatment with calcium alone or in combination with vitamin D than to treatment with vitamin D alone. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/10451461/A_comparison_of_calcium_vitamin_D_or_both_for_nutritional_rickets_in_Nigerian_children_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199908193410803?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -