Articles

Rickets on the Rise: A Case Series Highlighting the Importance of Growth Monitoring and Nutritional Assessment in Preventing Rickets

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Nutritional rickets, though a preventable condition, continues to show an increased incidence in clinical practice. It is crucial to recognize these cases during early stages in order to prevent the progression from vitamin D deficiency to clinical rickets, with the potential for irreversible complications. This case series describes five pediatric patients in which vitamin D deficiency and rickets was identified by close observation through growth monitoring and nutritional assessment. These workups were conducted due to the initial presentation of failure to thrive in each of these cases, prompting further evaluation to identify the underlying causes of growth faltering. A common theme throughout was normocalcemia, however, it is important to understand that this finding does not rule out the potential for rickets, as both subclinical rickets and stage two compensatory rickets can lead to normal laboratory findings. Therefore, growth faltering should always prompt nutritional assessment because early recognition, growth monitoring, a well-balanced diet with calcium-rich foods, compliance with vitamin D supplementation, and consistent follow-ups are essential to prevent the risk of developing clinical rickets.

Comparison of Serum Vitamin D Levels Between Arthralgia and Non-Arthralgia Groups Among Indoor Workers with Suspected Knee Osteoarthritis in Kupang City, Indonesia

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Background: Osteoarthritis is a degenerative joint disease commonly affecting the knee and often begins with joint pain or arthralgia. Vitamin D deficiency has been suggested as a contributing factor to musculoskeletal pain and cartilage metabolism disorders. Indoor workers may be at increased risk due to limited sunlight exposure and prolonged sitting duration.

Objective: To compare serum vitamin D levels between arthralgia and non-arthralgia groups among indoor workers with suspected knee osteoarthritis in Kupang City.

Methods: An observational analytic study with a cross-sectional design was conducted among 46 indoor workers from several government institutions in Kupang City. Participants were assessed through anamnesis, body mass index measurement, and evaluation of knee pain using the Visual Analogue Scale (VAS). Serum 25-hydroxyvitamin D levels were measured using the electrochemiluminescence immunoassay (ECLIA) method. Subjects were classified into arthralgia and non-arthralgia groups. Data were analyzed using the independent t-test.

Results: All participants were female, aged 18–59 years. Of the 46 respondents, 22 were classified as having arthralgia and 24 as non-arthralgia. A significant difference in serum 25-hydroxyvitamin D levels was observed between the two groups (p < 0.05). The arthralgia group showed a lower mean serum vitamin D level (17.2 ± 2.94 ng/mL) with a mean VAS score of 5.83, indicating moderate pain. In contrast, the non-arthralgia group had a higher mean serum vitamin D level (24.1 ± 2.51 ng/mL) with a VAS score of 0.

Conclusion: There was a significant difference in serum vitamin D levels between arthralgia and non-arthralgia indoor workers with suspected knee osteoarthritis in Kupang City, with lower vitamin D levels observed in the arthralgia group.

Failure to Thrive in an 18-Month-Old Female Infant with Rickets: A Case Report

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: Undetected vitamin D deficiency can lead to severe complications such as Rickets in infants. This case report describes an unusual case of an 18-month-old female infant who presented with failure to thrive early in infancy and was later diagnosed with Rickets. The infant initially presented with failure to thrive, labs were ordered, and findings demonstrated low 25-hydroxyvitamin D and elevated alkaline phosphatase. Radiographic imaging of the knee was ordered and showed transverse sclerotic metaphyseal bands involving the distal femoral metaphysis and portion of the proximal tibial metaphysis, findings consistent with untreated rickets. A thorough investigation was conducted to determine the primary cause of the vitamin D deficiency, identifying the primary cause as nutritional deficiency. Per endocrinology, the patient was started on cholecalciferol 800 IU daily with dietary changes. This case emphasizes the importance of checking vitamin D levels in all pediatric patients who present with failure to thrive.