Causes and management of nutritional rickets among paediatric age group in Rajasthan: a randomised control trial


  • Pinky Atal Department of Paediatrics, Government Medical College and Attached Group of Hospitals, Kota, Rajasthan, India
  • Jitendra Aloria Department of Orthopaedics, Government Medical College and Attached Group of Hospitals, Kota, Rajasthan, India
  • Meenakshi Chaudhary Department of Paediatrics, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
  • Mahendra Gosaliya Department of Orthopaedics, Government Medical College and Attached Group of Hospitals, Kota, Rajasthan, India
  • Aaditya Patni Department of Orthopaedics, Government Medical College and Attached Group of Hospitals, Kota, Rajasthan, India



Vitamin D, Calcium, Nutritional rickets, Genu varum, Genu valgus, Sun light


Background: Rickets disease frequently caused by insufficient of vitamin D. Nevertheless, subsequent researchers have attributed it to a calcium insufficiency throughout the eating plan. There is very little data on the relative efficacy of calcium, vitamin D, or both in the treatment of rickets. The goal of this study was to see if calcium, vitamin D, or a combination of the two may help young infants with nutritional rickets.

Methods: 100 patients of nutritional rickets aged 6 months to 5 years were randomly assigned to receive vitamin D (6,00,000 IU single intramuscular injection), calcium (75 mg/kg/day elemental calcium orally) or a combination. All of the participants' demographics, nutritional status, dietary calcium, and phytate consumption were evaluated.

Results: More than 80 percent of the patients in the study had 25OHD levels below 20 ng/ml. Rickets was discovered as an afterthought throughout the remaining 60. Lower respiratory illness (40), upper respiratory tract illness (10) and acute gastroenteritis have been the presenting conditions.

Conclusions: Children experiencing rickets exhibited low vitamin D levels in their blood as well as a low calcium intake from their nutrition. When compared to either vitamin D or calcium alone, the combination showed the best therapeutic effect.



Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-8.

Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004; 158:531-7.

Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: An international epidemiological investigation. J Intern Med. 2006;260:245-5.

Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension. 1997;30:150-6.

Thacher TD, Fischer PR, Pettifor JM. A compari son of calcium, vitamin D, or both for nutritional rick etc in Nigerian children. New Engl J Med. 1999;341:563-8

Thacher TD, Fischer PR, Pettifor JM. Case-control study of factors associated with nutritional rickets in Nigerian children. J Pediatr. 2000;137:367-73.

Fischer PR, Rahman A, Cimma JP, et al. Nutritional rickets without vitamin D deficiency in Bangladesh. J Trop Pediatr. 1999;45:291-3.

Okonofua F, Gill DS, Alabi ZO. Rickets in Nigerian children: a consequence of calcium malnutrition. Metabolism. 1991;40:209-13.

Oginni LM, Sharp CA, Badru OS. Radiological and biochemical resolution of nutritional rickets with calcium. Arch Dis Child. 2003;88:812-7.

Balasubramanian K, Rajeswari J, Gulab A. Varying role of vitamin D deficiency in the etiology of rickets in young children vs. adolescents in Northern India. J Trop Pediatr. 2003;49:201-6.

Hari Narayan CV, Rajalakshmi T, Prasad UV. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr. 2007;85:1062-7.

Bhatia V. Dietary calcium intake a critical re appraisal. Indian J Med Res. 2008;127:269-73.

Diet and nutritional status of population and prevalence of hypertension among adults in rural areas. Available at: management/ microdata-surveys/653. Accessed on 20 January 2022.

Akman AO, Tumer L, Hasanoglu A, et al. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int. 2011;53:968-73.

Yoon JH, Park CS, Seo JY. Clinical characteris tics and prevalence of vitamin D insufficiency in children less than two years of age. Korean J Pediatr. 2011;54: 298-303.

Davies JH, Reed JM, Blake E. Epidemiology of vitamin D deficiency in children presenting to a Pediatrics orthopaedic service in the UK. J Pediatr Orthop. 2011;31:798-802.

Marwaha RK, Tandon N, Reddy DR. Vitamin D and bone mineral density status of healthy school children in northern India. Am J Clin Nutr. 2005;82:477-82.

Seth A, Marwaha RK, Singla B, et al. Vitamin D nutritional status of exclusively breast-fed infants and their mothers. J Pediatrics Endocrinol Metab. 2009; 22:241-6.

Haddad JG. vitamin D solar rays, the Milky Way, or both?. N Engl J Med. 1992;326:121.

Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007;92:2130-5.

Chatfield SM, Brand C, Ebeling PR, Russell DM. Vitamin D deficiency in general medical inpatients in summer and winter. Intern Med J. 2007;37:377-82.

Awumey EM, Mitra DA, Hollis BW, Kumar R, Bell NH. Vitamin D metabolism is altered in Asian Indians in the southern United States: A clinical research center study. J Clin Endocrinol Metab. 1998;83:169-73.

Gloth FM, Gunberg CM, Hollis BW, Haddad JG, Tobin JD. Vitamin D deficiency in homebound elderly persons. JAMA 1995;274:1683-6.

Klein GL, Chen TC, Holick MF, Langman CB, Price H, Celis MM, et al. Synthesis of vitamin D in skin after burns. Lancet. 2004;363:291-2.

Carvalho NF, Kenney RD, Carrington PH, Hall DE. Severe nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics. 2001; 107:E46.

Hollis BW, Wagner CL. Vitamin D requirements during lactation: High-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004; 80:1752S.

Thandrayen K, Pettifor JM. Maternal vitamin D status: Implications for the development of infantile nutritional rickets. Endocrinol Metab Clin North Am. 2010;39:303.

Specker BL, Valanis B, Hertzberg V, Edwards N, Tsang RC. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatrics. 1985;107:37.

Formula fed nutrition during infancy: Principles and Practice. 2nd ed. In: Tsang RC, Zlotkin SH, Nichols BL, Hansen JW, eds. Cincinnati, OH: Digital Education Publishing; 1997:467.

Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1, 25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89:1196-9.

Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777-83.

Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90:3215-24.

Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti RO. Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy. Ann Intern Med. 1972;77:389.

Hughes DB, Mitha A, Bonjour JP, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporosis Int. 2010;21:1151-4.

Ross AC, Manson JE, Abrams SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the institute of medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53-8.

Thacher TD, Fischer PR, Pettifor JM. Radiographic scoring method for the assessment of the severity of nutritional rickets. J Trop Pediatr. 2000;46:132-9.

Pettifor JM, Ross P, Wang J. Rickets in children of rural origin in South Africa: is low dietary calcium a factor?. J Pediatr. 1978;92:320-4.

Clements MR, Johnson L, Fraser DR. A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature. 1987;325:62-5.

Kutluk G, Cetinkaya F, Bas M. Comparisons of oral calcium, high dose vitamin D and a combination of these in the treatment of nutritional rickets in children. J Trop Pediatr. 2002;48:351.




How to Cite

Atal, P., Aloria, J., Chaudhary, M., Gosaliya, M., & Patni, A. (2022). Causes and management of nutritional rickets among paediatric age group in Rajasthan: a randomised control trial. International Journal of Research in Medical Sciences, 10(8), 1668–1675.



Original Research Articles