Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia

Background: Nutritional rickets remains prevalent in many developing countries, despite the availability of ample sunlight. The aim of this study was to investigate the clinical features and chemical pathology in a group of children with rickets and to compare them with a control group. Subjects and Methods: In a case-control study over a 1-year period (March 2004 to February 2005), children clinically diagnosed with rickets (n = 61) were age- and sex-matched with controls (n = 58). In addition to routine chemical pathology, 25 (OH) vitamin D-3 and parathormone (PTH) were determined. Controls were children without clinical rickets attending hospital for other blood investigations. Results: The mean age of children with rickets was 14.8 mths and of controls was 16.5 mths. Mean (SD) body mass index of the children with rickets [16.8 (1.86)] was not significantly different from that of the controls [17.02 (3.16)]. Mean (SD) head circumference of rachitic children [45.41 (3.64) cm] was greater than that of controls [44.39 (5.07) cm, p = 0.03]. Eighty per cent of the children with rickets were breastfed compared with 67% of controls. Thirty per cent of children with rickets were hypocalcaemic vs < 7% of controls, 89% had phosphorus values < 1.5 mmol/L vs 34.5% of controls and 75% had alkaline phosphatise levels > 500 IU/L vs 28% of controls. Seventy-five per cent of children with rickets had serum 25 (OH) D3 < 20 nmol/L vs 25% of controls. Mean (SD) PTH level was 23.59 (19.03) pmol/L in the rachitic group and 1.9 (1.05) pmol/L in controls (p < 0.05). Lack of exposure to sunlight was recorded in 90% of the children with rickets and in 37% of the controls. Conclusion: Apparently healthy children living in areas where rickets is prevalent have risk factors for rickets and a small proportion will have evidence of biochemical rickets.