Follow-up of Gambian rickets: possible aetiological factors

Abstract

Event Abstract Back to Event Follow-up of Gambian rickets: possible aetiological factors VB Braithwaite1*, LMA Jarjou2, GR Goldberg1, 2, S Nigdikar1, H Jones1 and A Prentice1, 2 1 MRC Human Nutrition Research, United Kingdom 2 MRC Keneba, Gambia A case-series of children (n=46) with suspected calcium-deficiency rickets presented at MRC clinics in The Gambia with rickets-like bone deformities. Biochemical analyses discounted vitamin D-deficiency as an aetiological factor but indicated a perturbation of Ca-P metabolism involving low plasma phosphate and high circulating C-terminal fibroblast growth factor-23 (FGF23) [1]. The children were treated with calcium and vitamin D for 6-12 months. A follow-up study was conducted 4-5 years after presentation to investigate possible aetiology and characterise recovery. {BR}35 children (RFU) consented to follow-up. Standardised clinical examinations to assess severity of bone deformities, 2hr fasting urine and blood sample collection, 48hr weighed dietary analysis and 24hr urine collections were made. Data from children from the local community (LC) were used to calculate standard deviation scores (SDS) to control for age, sex and season. {BR}None of RFU had radiological signs of active rickets. However, 54% (n=19) had visible leg deformities consistent with rickets, including 4 whose deformity had changed from genu varum to valgum, while the others had no lasting deformity.{BR}Differences in biochemical and dietary profile were observed between RFU and LC. These included lower dietary calcium intake (SDS=-0.5, p=0.02), daily urinary calcium excretion (SDS=-0.7, p=0.03), TmP:GFR (SDS=-0.5, p=0.04) and eGFR-cystatinC (SDS=-0.9, p=0.03). FGF23 tended to be higher (SDS=0.4, p=0.5). Haemoglobin (Hb) was a negative predictor of FGF23 in RFU (lnFGF23=21.9-7.14lnHb, R2=26.6%, p=0.006) but not in LC (lnFGF23=0.43+1.47lnHb, R2=4.8%,p=0.3). There was an Hb x group interaction (p=0.003) demonstrating a difference in slope in the relationship between Hb and FGF23 in the two groups.{BR}Differences were apparent between RFU with and without lasting leg deformities. These included higher circulating 1,25OH2D (SDS=0.6, p=0.05) and magnesium (SDS=0.3, p=0.008) and lower eGFR-cystatinC (SDS=-0.9, p=0.01) in those with lasting deformity. {BR}In conclusion, differences in biochemical and dietary profile exist between Gambian children 4-years after initial presentation with rickets and children from the local community. In addition, biochemical differences are apparent in those who recover from bone deformities and those who do not. Our results suggest low dietary calcium intake, poor glomerular filtration and low iron status as potential aetiological factors in Gambian Rickets. {BR}1. Prentice. Bone2008.42:p.788-797. Keywords: Bones, Bone Research Conference: 2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society, Cambridge, United Kingdom, 27 Jun - 29 Jun, 2011. Presentation Type: Poster Topic: Abstracts Citation: Braithwaite V, Jarjou L, Goldberg G, Nigdikar S, Jones H and Prentice A (2011). Follow-up of Gambian rickets: possible aetiological factors. Front. Endocrinol. Conference Abstract: 2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society. doi: 10.3389/conf.fendo.2011.02.00007 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Sep 2011; Published Online: 30 Sep 2011. * Correspondence: Prof. VB Braithwaite, MRC Human Nutrition Research, Cambridge, United Kingdom, vb287@cam.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers VB Braithwaite LMA Jarjou GR Goldberg S Nigdikar H Jones A Prentice Google VB Braithwaite LMA Jarjou GR Goldberg S Nigdikar H Jones A Prentice Google Scholar VB Braithwaite LMA Jarjou GR Goldberg S Nigdikar H Jones A Prentice PubMed VB Braithwaite LMA Jarjou GR Goldberg S Nigdikar H Jones A Prentice Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.