Original articleIncreasing Incidence of Nutritional Rickets: A Population-Based Study in Olmsted County, Minnesota
Section snippets
Olmsted County and the Rochester Epidemiology Project
Olmsted County is located in the upper midwestern United States (centered at 44° North latitude). The population of Olmsted County increased from 82,955 in 1970 to 145,225 in 2009. Despite the 75% increase in total population, the number of children younger than 3 years, who are at greatest risk of rickets, had a much smaller increase—from 5133 in 1970 to 6277 in 2009 (a 22% increase). Racial diversity has been increasing. In the 2000 and 2010 censuses, the proportions of Olmsted County
Results
In total, 768 medical records were identified using the eligible diagnostic codes; diagnoses included leg deformities (n=517), hypocalcemia or tetany (n=131), vitamin D deficiency (n=60), osteomalacia (n=23), rickets (n=27), and craniotabes (n=10). Of the 369 patients who underwent radiography, 23 (6%) had confirmed rickets, and 17 of these (74%) were judged to have nutritional rickets. Of the 6 excluded cases of confirmed rickets, 3 had hypophosphatemic rickets and 1 each had rickets of
Discussion
As a population-based incidence study over 40 years, this report provides better information regarding the incidence and temporal trends of diagnosed nutritional rickets than previous studies. Unlike other case series, this study had the advantage of a defined population (ie, denominator), and, consequently, we could determine the actual incidence trend of nutritional rickets without the risk of referral bias. By requiring radiographic evidence of rickets, we avoided disease misclassification
Conclusion
We provide population-based evidence that the incidence of rickets has dramatically increased since 2000. Because all cases of nutritional rickets in this study were identified in children younger than 3 years, strategies for rickets prevention should focus on infants and toddlers. These strategies include vitamin D supplementation of breast-fed infants and ensuring adequate maternal vitamin D status during pregnancy, particularly in black children and in children who have recently entered the
Acknowledgment
The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
References (36)
Nutritional rickets: deficiency of vitamin D, calcium, or both?
Am J Clin Nutr
(2004)- et al.
Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003
Am J Clin Nutr
(2004) - et al.
Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004
Am J Clin Nutr
(2008) - et al.
Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project
Mayo Clin Proc
(2012) Resurrection of vitamin D deficiency and rickets
J Clin Invest
(2006)Is nutritional rickets returning?
Arch Dis Child
(2004)- et al.
Nutritional rickets in Georgia
Pediatrics
(2001) - et al.
Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004
Arch Intern Med
(2009) - et al.
Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake
Pediatrics
(2003) - et al.
Prevention of rickets and vitamin D deficiency in infants, children, and adolescents
Pediatrics
(2008)
Prevalence of vitamin D deficiency among healthy infants and toddlers
Arch Pediatr Adolesc Med
Weather or not: the importance of vitamin D status monitoring and supplementation
Minn Med
10-Year case review of nutritional rickets in Children's Hospital of Michigan
Clin Pediatr (Phila)
The re-emerging burden of rickets: a decade of experience from Sydney
Arch Dis Child
Recent trends and clinical features of childhood vitamin D deficiency presenting to a children's hospital in Glasgow
Arch Dis Child
Vitamin D deficiency in children and its management: review of current knowledge and recommendations
Pediatrics
Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project
Am J Epidemiol
Cited by (0)
Grant Support: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award R01AG034676 and by the Mayo Clinic Department of Family Medicine.
Potential Competing Interests: Dr Thacher has received honoraria for authoring medical education materials on vitamin D deficiency.