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Indian Pediatr 2014;51: 260-261 |
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Is Single Oral Dose of 300,000 IU Vitamin D3
Adequate for
Treatment of Nutritional Rickets?
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Benjamin Jacobs
Consultant Pediatrician and Director of Children’s
Service Royal National Orthopaedic Hospital,
Stanmore, UK.
Email: [email protected]
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N utritional Rickets has recently re-emerged as a
problem in many countries where it was thought to have been eradicated
[1]. Recent analysis shows that hospitalization rates for rickets in
England are now the highest in five decades [2].
Still, many modern clinicians in developed countries
have little experience or training in the management of this condition.
The study published in this issue [3] is helpful in highlighting the
efficacy of a simple single dose regimen, and shows that the lower dose
of 300,000 units is not inferior to double this dose. It is also
important to stress that the dose is effective orally. Many children are
treated with the same dose by intra-muscular injection which is painful
and unnecessary. This study shows good clinical outcomes, and is in line
with other clinical and pharmacokinetic studies showing effectiveness of
oral Vitamin D therapy [4,5]. The practice of injecting children should
stop, except for rare instances – such as rickets associated with severe
malabsorption – where even high oral doses are ineffective.
The authors comment on the risk of hypercalcaemia,
but this study was not designed or powered to assess this potential
side-effect of vitamin D therapy. Hypercalcemia may be due to other
causes and should not prevent clinicians treating rickets with adequate
doses of vitamin D and/or calcium. Also it is important to remember that
after effective treatments, such as those used in this study, a
satisfactory blood level of vitamin D at follow-up should not encourage
clinicians or families to stop the regular low-dose prevention of doses
of vitamin D which are required long-term to prevent relapse of rickets.
It is my practice to recommend children diagnosed with rickets to take
1000 units of vitamin D daily to until they have finished growing, which
would be more than 10 years for most of the children in this study.
Appropriate vitamin D and calcium intake should be also encouraged for
their siblings. That way many cases of rickets can be prevented. The
financial savings in terms of blood tests, X-rays and clinical follow-up
should more than balance the cost of the vitamin D.
Funding: None; Competing interests: None
stated.
References
1. Lowdon J. Rickets: concerns over the worldwide
increase. J Fam Health Care. 2011;21:25-9.
2. Goldacre M, Hall N, Yeates DG. Hospitalisation for
children with rickets in England: a historical perspective. Lancet.
2014;383:597-8.
3. Mittal H, Rai S, Shah D, Madhu SV, Mehrotra G,
Malhotra RK, et al. 300,000 IU or 600,000 IU of oral vitamin D3
for treatment of nutritional rickets: A randomized controlled trial.
Indian Pediatr. 2014; 51:265-72.
4. Balasubramanian S, Dhanalakshmi K, Amperayani S.
Vitamin D deficiency in childhood – a review of current guidelines on
diagnosis and management. Indian Pediatr. 2013;50:669-75.
5. Shah BR, Finberg L. Single-day therapy for
nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr.
1994;125:487-90.
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