Bone Abstracts

This paper reviews clinical reports of vitamin D deficiency rickets in neonates from 1930 onwards. In 24 reports there was good evidence of maternal deficiency. In some the diagnosis of the rickets led to the identification of symptomatic osteomalacia in the mothers; several had been severe and longstanding. Of the 15 mothers who had assays for serum 25-hydroxyvitamin D (25OHD) 13 had values <25 nmol/l (10 ng/ml) and 10 had values <12.5 nmol/l (5 ng/ml).

Presentations in the infants included craniotabes, wide skull sutures, rachitic rosaries, enlargement of the wrists and ankles, tetany and hypocalcemic convulsions. In three cases rickets had been suspected from antenatal X-rays. In four cases fractures were found at the time of initial presentation. Of the 19 infants with serum calcium assays 12 had values lower than 2.0 mmol/l (8.0 mg/dl). A variety of methods had been used for serum alkaline phosphatase assays but of 18 infants at least 15 had abnormally high levels for a child. Of the 11 infants in whom serum 25OHD was measured before treatment, all had values <25 nmol/l (10 ng/ml). Eight had values <12.5 nmol/l (5 ng/ml). Seven infants had assays for serum parathyroid hormone; all had substantially raised values.

These reports provide strong support for the view that maternal deficiency leads to overt bone disease from before birth. Larger surveys have shown that maternal deficiency leads to long-term impairment of bone quality in postnatal life. The importance of ensuring adequate vitamin D nutrition in pregnancy is emphasised.