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Dittmar JM, Inskip SA, Rose AK, Cessford C, Mitchell PD, O'Connell TC, Robb JE. Health inequality in medieval Cambridge, 1200-1500 CE. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024:e24993. [PMID: 39180499 DOI: 10.1002/ajpa.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/09/2024] [Accepted: 06/19/2024] [Indexed: 08/26/2024]
Abstract
Health inequality is not only a major problem today; it left its mark upon past societies too. For much of the past, health inequality has been poorly studied, mostly because bioarchaeologists have concentrated upon single sites rather than a broader social landscape. This article compares 476 adults in multiple locations of medieval Cambridge (UK). Samples include ordinary townspeople (All Saints), people living in a charitable institution (the Hospital of St. John), and members of a religious order (the Augustinian Friary). These groups shared many conditions of life, such as a similar range of diseases, risk of injury, and vertebral disk degeneration. However, people living on charity had more indicators of poor childhood health and diet, lower adult stature, and a younger age at death, reflecting the health effects of poverty. In contrast, the Augustinian friars were members of a prosperous, well-endowed religious house. Compared with other groups, they were taller (perhaps a result of a richer diet during their adolescent growth period); their adult carbon and nitrogen isotope values are higher, suggesting a diet higher in terrestrial and/or marine animal protein; and they had the highest prevalence of foot problems related to fashionable late medieval footwear. As this illustrates, health inequality will take particular forms depending upon the specificities of a social landscape; except in unusual circumstances where a site and its skeletal samples represent a real cross-section of society, inequality is best investigated by comparison across sites.
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Affiliation(s)
- Jenna M Dittmar
- Department of Anatomy, Edward Via College of Osteopathic Medicine, New Orleans, USA
| | - Sarah A Inskip
- School of Archaeology and Ancient History, University of Leicester, UK
| | - Alice K Rose
- Department of Archaeology, University of York, York, UK
| | - Craig Cessford
- Cambridge Archaeological Unit, University of Cambridge, UK
| | | | | | - John E Robb
- Department of Archaeology, University of Cambridge, UK
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Zhumalina A, Tusupkaliev B, Mania A, Kim I, Zharlykasinova M. The Importance of Determining the Level of Bone Metabolism Markers and Vitamin D in the First Year of Life in the Kazakh Population. J Pediatr Pharmacol Ther 2024; 29:410-416. [PMID: 39144381 PMCID: PMC11321809 DOI: 10.5863/1551-6776-29.4.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/22/2023] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The research aimed to determine the importance of vitamin D and markers of bone metabolism in the overall assessment of bone mineralization during a child's first year of life. METHODS The 198 children were selected by screening all infants seen at our pediatric clinic over a 2-year period from 2020-2022 and including those who met the eligibility criteria of being aged 0 to 1 year, healthy with no chronic conditions, and not on vitamin D supplementation. Children were divided into 3 groups depending on the content of vitamin D in the blood serum: sufficient, insufficient, and deficient. The markers of bone tissue status included: markers of mineral metabolism (calcium, phosphorus, parathyroid hormone, calcitonin), a marker of bone formation (osteocalcin), resorption marker (deoxypyridinoline). Laboratory values were obtained at the time of study enrollment during the initial study visit. Labs were not repeated during the course of the study. RESULTS A quarter of the infants exhibited vitamin D deficiency at enrollment with serum 25OHD concentrations below 20 ng/mL, which showed a positive correlation with serum calcium and phosphorus -concentrations and a negative correlation with PTH, while osteocalcin and deoxypyridinoline concentrations remained consistent regardless of vitamin D status. CONCLUSIONS The study's practical significance allows for the recommendation of using vitamin D -concentrations as a marker to detect bone formation and mineral metabolism disorders in children during their first year of life. By identifying and addressing these issues early on, the health care system aims to ensure better musculoskeletal health for children.
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Affiliation(s)
- Akmaral Zhumalina
- Department of Children’s Diseases No. 1 with Neonatology (AZ, BT, IK, MZ), West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan
| | - Balash Tusupkaliev
- Department of Children’s Diseases No. 1 with Neonatology (AZ, BT, IK, MZ), West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology (AM), Poznan University of Medical Sciences, Poznan, Poland
| | - Irina Kim
- Department of Children’s Diseases No. 1 with Neonatology (AZ, BT, IK, MZ), West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan
| | - Mairamkul Zharlykasinova
- Department of Children’s Diseases No. 1 with Neonatology (AZ, BT, IK, MZ), West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan
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3
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Pitts S. Bone Health: A Review. Pediatr Rev 2024; 45:440-449. [PMID: 39085182 DOI: 10.1542/pir.2023-006167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Sarah Pitts
- Division of Adolescent/Young Adult Medicine and Division of Endocrinology, Boston Children's Hospital, and Harvard Medical School, Boston, MA
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García-Domínguez M, Gutiérrez-Del-Río I, Villar CJ, Perez-Gomez A, Sancho-Martinez I, Lombó F. Structural diversification of vitamin D using microbial biotransformations. Appl Microbiol Biotechnol 2024; 108:409. [PMID: 38970663 PMCID: PMC11227467 DOI: 10.1007/s00253-024-13244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
Vitamin D deficiencies are linked to multiple human diseases. Optimizing its synthesis, physicochemical properties, and delivery systems while minimizing side effects is of clinical relevance and is of great medical and industrial interest. Biotechnological techniques may render new modified forms of vitamin D that may exhibit improved absorption, stability, or targeted physiological effects. Novel modified vitamin D derivatives hold promise for developing future therapeutic approaches and addressing specific health concerns related to vitamin D deficiency or impaired metabolism, such as avoiding hypercalcemic effects. Identifying and engineering key enzymes and biosynthetic pathways involved, as well as developing efficient cultures, are therefore of outmost importance and subject of intense research. Moreover, we elaborate on the critical role that microbial bioconversions might play in the a la carte design, synthesis, and production of novel, more efficient, and safer forms of vitamin D and its analogs. In summary, the novelty of this work resides in the detailed description of the physiological, medical, biochemical, and epidemiological aspects of vitamin D supplementation and the steps towards the enhanced and simplified industrial production of this family of bioactives relying on microbial enzymes. KEY POINTS: • Liver or kidney pathologies may hamper vitamin D biosynthesis • Actinomycetes are able to carry out 1α- or 25-hydroxylation on vitamin D precursors.
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Affiliation(s)
- Mario García-Domínguez
- Research Group BIONUC (Biotechnology of Nutraceuticals and Bioactive Compounds), Departamento de Biología Funcional, Principality of Asturias, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain
- IUOPA (Instituto Universitario de Oncología del Principado de Asturias), Oviedo, Spain
- ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Ignacio Gutiérrez-Del-Río
- Research Group BIONUC (Biotechnology of Nutraceuticals and Bioactive Compounds), Departamento de Biología Funcional, Principality of Asturias, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain
- IUOPA (Instituto Universitario de Oncología del Principado de Asturias), Oviedo, Spain
- ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Claudio J Villar
- Research Group BIONUC (Biotechnology of Nutraceuticals and Bioactive Compounds), Departamento de Biología Funcional, Principality of Asturias, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain
- IUOPA (Instituto Universitario de Oncología del Principado de Asturias), Oviedo, Spain
- ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | | | | | - Felipe Lombó
- Research Group BIONUC (Biotechnology of Nutraceuticals and Bioactive Compounds), Departamento de Biología Funcional, Principality of Asturias, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain.
- IUOPA (Instituto Universitario de Oncología del Principado de Asturias), Oviedo, Spain.
- ISPA (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain.
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Järvelin UM, Järvelin JM. Significance of vitamin D responsiveness on the etiology of vitamin D-related diseases. Steroids 2024; 207:109437. [PMID: 38723841 DOI: 10.1016/j.steroids.2024.109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
Vitamin D resistance (VDRES) explains the necessity for higher doses of Vitamin D (VD) than those recommended for treatment success. VD receptor (VDR) signaling blockade, such as that caused by infections and poisons, is one basis for VDRES etiology. Mutations within genes affecting the VD system cause susceptibility to developing low VD responsiveness and autoimmunity. In contrast, VD hypersensitivity (VDHY) occurs if there is extra VD in the body; for example, as a result of an overdose of a VD supplement. Excess 1,25(OH)2D3 is produced in lymphomas and granulomatous diseases. The placenta produces excess 1,25(OH)2D3. Gene mutations regulating the production or degradation of 1,25(OH)2D3 enhance the effects of 1,25(OH)2D3. Increased 1,25(OH)2D3 levels stimulate calcium absorption in the gut, leading to hypercalcemia. Hypercalcemia can result in the calcification of the kidneys, circulatory system, or placenta, leading to kidney failure, cardiovascular disease, and pregnancy complications. The primary treatment involves avoiding exposure to the sun and VD supplements. The prevalence rates of VDRES and VDHY remain unclear. One estimate was that 25%, 51%, and 24% of the patients had strong, medium, and poor responses, respectively. Heavy-dose VD therapy may be a promising method for the treatment of autoimmune diseases; however, assessing its potential side effects is essential. To avoid VD-mediated hypercalcemia, responsiveness must be considered when treating pregnancies or cardiovascular diseases associated with VD. Furthermore, how VD is associated with the related disorders remains unclear. Investigating responsiveness to VD may provide more accurate results.
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Affiliation(s)
- Ulla M Järvelin
- Tampere University, Medical Faculty, Department of Anatomy (2005 - 2009), Arvo Ylpönkatu 34, 33520 Tampere, Finland; Tampere University Hospital (2009 - 2021), Ensitie 8, 33520 Tampere, Finland.
| | - Juho M Järvelin
- Turku University, Medical Faculty, Department of General Medicine, 20014 Turun yliopisto, Finland.
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Alsagheir A, Al-Ashwal A, Binladen A, Alhuthil R, Joueidi F, Ramzan K, Imtiaz F. Clinical characteristics and long-term management for patients with vitamin D-dependent rickets type II: a retrospective study at a single center in Saudi Arabia. Front Endocrinol (Lausanne) 2024; 15:1365714. [PMID: 38872968 PMCID: PMC11169865 DOI: 10.3389/fendo.2024.1365714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/09/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Hereditary Vitamin D-dependent rickets type II (HVDDR-type II) is a rare autosomal recessive disorder caused by molecular variation in the gene encoding the vitamin D receptor (VDR). This study aims to evaluate phenotype and genotype characteristics and long-term follow-up of the largest group of patients with (HVDDR-type II) in Saudi Arabia. Methodology We conducted a retrospective chart review to collect the clinical, biochemical, and genetic data for all HVDDR-type II patients currently receiving treatment at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Results A total of 42 patients, 57.1% female, and 42.9% male were included in the study. Seven patients were treated with high doses of oral calcium, while 35 patients were treated with IV calcium infusion. The median age at presentation was 15.5 months. Alopecia was found in 97.6%, 21.4% presented with bowing legs, 14.3% with delayed walking, 9.5% with seizure, and 2.4% presented with respiratory failure, while a family history of the disease was positive in 71.4% of total patients. Molecular genetic testing of the VDR gene in our cohort identified six different gene variants c.885 C>A (p.Tyr295Ter), c.88 C>T (p.Arg30Ter), c.1036G>A (p.Val346Met), c.820C>T (p.Arg274Cys), c.803 T>C (p.Ile268Thr), and c.2T>G (p.Met1?). Conclusion We are describing the largest cohort of patients with HVDDR-type II, their clinical biochemical findings, and the most prevalent genetic variants in our population.
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Affiliation(s)
- Afaf Alsagheir
- Section of Pediatric Endocrinology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Al-Ashwal
- Section of Pediatric Endocrinology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amal Binladen
- Section of Pediatric Endocrinology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raghad Alhuthil
- Section of Pediatric Endocrinology, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faisal Joueidi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Khushnooda Ramzan
- Department of Clinical Genomics, Centre of Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faiqa Imtiaz
- Department of Clinical Genomics, Centre of Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Proctor KB, Mansoura M, Rodrick E, Volkert V, Sharp WG, Kindler JM. The relationship between food selectivity and stature in pediatric patients with avoidant-restrictive food intake disorder - an electronic medical record review. J Eat Disord 2024; 12:64. [PMID: 38773584 PMCID: PMC11110304 DOI: 10.1186/s40337-024-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND We aimed to characterize stature in pediatric patients with avoidant/restrictive food intake disorder (ARFID), including associations between body size and nutrient intake and height. METHODS We conducted a secondary analysis of pre-treatment data from 60 patients diagnosed with ARFID that were collected from the electronic medical record. Anthropometric measurements were converted to age- and sex-specific Z-scores using pediatric CDC growth charts. Spearman correlations were performed to test the relationship between height and weight/BMI Z-scores as well as height Z-score and diet variables. RESULTS On average, height (-0.35 ± 1.38), weight (-0.58 ± 1.56), and BMI (-0.56 ± 1.48) Z-scores tended to be lower than what would be expected in a generally healthy pediatric population. Percent of individuals with height, weight, or BMI Z-score < -2.0 was 8%, 20%, and 17%, respectively. BMI (P < 0.05) and weight (P < 0.05) were positively associated with height Z-score. Further, intake of some nutrients (e.g., calcium, vitamin D) correlated positively with height Z-score (all P < 0.05). CONCLUSIONS The cross-sectional relationships reported in this study suggest that in children with ARFID, body weight and consumption of bone-augmenting nutrients such as calcium and vitamin D correlated with height. A thorough understanding of the clinical manifestations of malnutrition and longitudinal effects of restrictive eating in patients with ARFID is critical.
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Affiliation(s)
- Kaitlin B Proctor
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maryam Mansoura
- Medical College of Georgia, Augusta University, University of Georgia Medical Partnership, Augusta, GA, USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Valerie Volkert
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - William G Sharp
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA.
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Bandyopadhyay S, Jain N, Bandyopadhyay A. Anaesthetic concerns of a child with symptomatic vitamin D deficiency rickets with secondary hyperparathyroidism: A case report. J Perioper Pract 2024:17504589241242229. [PMID: 38606917 DOI: 10.1177/17504589241242229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Rickets is a paediatric bone disorder characterised by defective mineralisation of bony matrix due to abnormalities in calcium and phosphate metabolism. Despite being a common disease globally, literature on the anaesthetic concerns in rickets are scant. Herein, we describe the management of a 12-year-old child with symptomatic vitamin D deficiency rickets with secondary hyperparathyroidism, undergoing general anaesthesia for an urgent orthopaedic procedure. There are numerous risks involved in such a case, such as hypocalcemia, hypophosphatemia, chest and vertebral deformities, restrictive lung disease, difficult intubation and weaning, difficult regional anaesthesia, chronic bone pain, infectious complications and postoperative decreased renal function, all of which require careful preoperative assessment and risk stratification. In elective surgeries, it is important to optimise the metabolic parameters before taking up the case. However, in urgent and emergent procedures like ours, it is imperative to take up the case after informing the parents of the risks involved.
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Affiliation(s)
- Soumily Bandyopadhyay
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nisha Jain
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjishnujit Bandyopadhyay
- Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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de Brito Chagas J, Cordinhã C, do Carmo C, Alves C, Heath KE, Sousa SB, Gomes C. Vitamin D-Dependent Rickets Type 1A in Two Siblings with a Hypomorphic CYP27B1 Variant Frequent in the African Population. J Pediatr Genet 2024; 13:43-49. [PMID: 38567179 PMCID: PMC10984714 DOI: 10.1055/s-0041-1736559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Vitamin D-dependent type 1A rickets (VDDR-1A) is a rare autosomal recessive disease due to the inability to convert 25-hydroxyvitamin D [25(OH)D] to the active form 1.25-dihydroxyvitamin D [1.25(OH) 2 D] by the enzyme 25(OH)D-1α-hydroxylase leading to low or low-normal serum levels of [1.25(OH) 2 D]. We report two sisters with rickets in whom the diagnosis of VDDR-1A was a challenge. They had normal 1.25(OH)2D levels, which are unusual with this condition but may be explained by the identified genotype. Both have compound heterozygous for two, most likely, hypomorphic CYP27B1 alleles: the novel p.(Arg117Gly) variant, and p.(Ala129Thr), which are present in 0.43% of the African population. This report illustrates the variability of clinical, laboratory, and radiological presentation between two sisters with the same genotype, during phases of faster or slower growth. Genetic testing was crucial for establishing the diagnosis that optimized the management and genetic counseling.
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Affiliation(s)
- Joana de Brito Chagas
- Pediatric Department, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
| | - Carolina Cordinhã
- Pediatric Department, Pediatric Nephrology Unit, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
| | - Carmen do Carmo
- Pediatric Department, Pediatric Nephrology Unit, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
| | - Cristina Alves
- Department of Pediatric Orthopaedics, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
| | - Karen E. Heath
- Institute of Medical and Molecular Genetics, IdiPAZ, Hospital Universitario La Paz, UAM, Madrid, Spain
- Skeletal Dysplasia Multidisciplinary Unit and ERN-BOND, Hospital Universitario La Paz, Madrid, Spain; CIBERER, ISCIII, Madrid, Spain
| | - Sérgio B. Sousa
- Medical Genetics Unit, Skeletal Dysplasia Multidisciplinary Centre and ERN-BOND, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinic of Genetics, Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Clara Gomes
- Pediatric Department, Pediatric Nephrology Unit, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
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Biasucci G, Donini V, Cannalire G. Rickets Types and Treatment with Vitamin D and Analogues. Nutrients 2024; 16:416. [PMID: 38337700 PMCID: PMC10857029 DOI: 10.3390/nu16030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The definition of "Vitamin D" encompasses a group of fat-soluble steroid compounds of different origins with similar chemical structures and the same biological effects. Vitamin D deficiency and/or a defect in the process of its synthesis or transport predispose individuals to several types of rickets. In addition to cholecalciferol, ergocalciferol, and vitamins D3 and D2, there are also active metabolites for the treatment of this condition which are commercially available. Calcitriol and aphacalcidiol are active metabolites that do not require the renal activation step, which is required with calcifediol, or hepatic activation. The purpose of this review is to summarize current approaches to the treatment of rickets for generalist physicians, focusing on the best vitamin D form to be used in each type, or, in the case of X-linked hypophosphatemic rickets (XLH), on both conventional and innovative monoclonal antibody treatments.
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Affiliation(s)
- Giacomo Biasucci
- Pediatrics and Neonatology Unit, University of Parma, Gugliemo da Saliceto Hospital, 29121 Piacenza, Italy;
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Valentina Donini
- Unit of Pediatrics, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Giuseppe Cannalire
- Pediatrics and Neonatology Unit, University of Parma, Gugliemo da Saliceto Hospital, 29121 Piacenza, Italy;
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Capossela L, Ferretti S, D’Alonzo S, Di Sarno L, Pansini V, Curatola A, Chiaretti A, Gatto A. Bone Disorders in Pediatric Chronic Kidney Disease: A Literature Review. BIOLOGY 2023; 12:1395. [PMID: 37997994 PMCID: PMC10669025 DOI: 10.3390/biology12111395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Intense changes in mineral and bone metabolism are frequent in chronic kidney disease (CKD) and represent an important cause of morbidity and reduced quality of life. These disorders have conventionally been defined as renal osteodystrophy and classified based on bone biopsy, but due to a lack of bone biopsy data and validated radiological methods to evaluate bone morphology in children, it has been challenging to effectively assess renal osteodystrophy in pediatric CKD; the consequence has been the suboptimal management of bone disorders in children. CKD-mineral and bone disorder (CKD-MBD) is a new expression used to describe a systemic disorder of mineral and bone metabolism as a result of CKD. CKD-MBD is a triad of biochemical imbalances in calcium, phosphate, parathyroid hormone, and vitamin D; bone deformities and soft tissue calcification. This literature review aims to explore the pathogenesis, diagnostic approach, and treatment of CKD-MBD in children and the effects of renal osteodystrophy on growing skeleton, with a specific focus on the biological basis of this peculiar condition.
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Affiliation(s)
- Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Silvia D’Alonzo
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy;
| | - Lorenzo Di Sarno
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
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12
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Alvear-Vega S, Benavente-Contreras R, Vargas-Garrido H. Social determinants of serum 25-hydroxyvitamin D concentrations deficiency in older Chilean people. Sci Rep 2023; 13:18355. [PMID: 37884637 PMCID: PMC10603156 DOI: 10.1038/s41598-023-45862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023] Open
Abstract
Serum 25-hydroxyvitamin D concentrations deficiency is a growing health problem that affects a significant part of the world's population, with particularly negative consequences in children and older adults. Public health has prioritized healthy aging; thus, an investigation of the social determinants related to deficient and insufficient Serum 25-hydroxyvitamin D concentrations in older adults is needed to contribute to the implementation of comprehensive social programs focused on addressing those conditions adversely affecting the health of this group. This study was conducted using a sample of older adults (age ≥ 65 years, n = 1283) from the National Health Survey (NHS 2016-2017). The Average Marginal Effects of the social determinants of Serum 25-hydroxyvitamin D concentrations deficiency in older adults were predicted using a probit model in which the outcome variable assumed two values (deficiency or not deficiency), taking as independent variables those reported in previous studies. The model showed an adequate goodness of fit, Count R2 = 0.65, and the independent variables explained between 11% (Cox-Snell) and 14% (Nagelkerke) of the variance of the outcome variable. The social determinants associated with a greater likelihood of Serum 25-hydroxyvitamin D concentrations deficiency are the following conditions: women, people of native origin, urban dwellers, shorter sunlight exposure, and greater geographical latitude. Implications are discussed, and limitations are considered. Promotion and prevention programs should preferentially target older adults in the southernmost regions who live in urban areas, with a special focus on women. Due to the country's characteristics (17°-57° south latitude), it is necessary to review in future research the three zones shown in this study as relevant social determinants for the older adults living in them to generate inputs in formulating public health policies. The authorities must define the cut-off points for considering the difference between the country's ranges of Serum 25-hydroxyvitamin D concentrations insufficiency and deficiency.
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Alsabri M, Street H, Sircy A, Labib B. Misdiagnosed metabolic bone abnormality: a case report. J Med Case Rep 2023; 17:436. [PMID: 37858137 PMCID: PMC10588102 DOI: 10.1186/s13256-023-04164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Metabolic bone disease causes significant morbidity and mortality, especially when misdiagnosed. With genetic testing, multiple disease pathologies can be analyzed. CASE PRESENTATION A 5-year and 9-month-old otherwise healthy Yemeni girl presented to her Yemen physician for evaluation of inward bending of her right knee and short stature. After extensive medical testing, she was given a diagnosis of hypophosphatemic rickets and growth hormone deficiency and started on treatment. Despite appropriate treatment, however, her condition continued to progress, prompting her family to pursue additional workup including genetic testing outside of Yemen. Genetic testing ultimately revealed a variation of unknown significance associated with amelogenesis imperfecta. CONCLUSIONS Hypophosphatemic rickets secondary to renal tubular acidosis was the working diagnosis. However, the patient's condition did not improve. Further genetic testing revealed a variation of unknown significance associated with amelogenesis imperfecta. We aim to present this case, provide an overview of the causes, and diagnostic metabolic bone health evaluation.
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Affiliation(s)
- Mohammed Alsabri
- Pediatrics, 1 Brookdale University Hospital and Medical Center, 1Brookdale Plaza, Brooklyn, NY, 11212, USA.
- Emergency Medicine Department, Al Thawra Modern General Hospital (TMGH), Sana'a City, Yemen.
- College of Osteopathic Medicine, NYIT, Glen Head, NY, USA.
| | - Hannah Street
- NYU Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA
| | - Aaron Sircy
- CMEF Aultman Hospital, 2600 6th st. SW, Canton, OH, 44710, USA
| | - Bahaaeldin Labib
- Rutgers-Robert Wood Johnson University Hospital, 200 Somerset Street, New Brunswick, NJ, 08901, USA
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Darraj H, Hakami KM, Maghrabi R, Bakri N, Alhazmi MH, Names AA, Akkur A, Sayegh M, Alhazmi A, Khubrani SM, Gohal G, Alomar AH, Alhazmi AH. Nutritional Rickets Among Children: A Retrospective Study from Saudi Arabia. Pediatric Health Med Ther 2023; 14:301-308. [PMID: 37849986 PMCID: PMC10577373 DOI: 10.2147/phmt.s425459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
Background Nutritional rickets remains a significant concern in certain countries, with increasing prevalence attributed to factors such as limited sunlight exposure and undernourishment. This study aimed to identify the factors associated with rickets due to nutritional deficiency in children from Jazan Province, southwestern Saudi Arabia. Methods A retrospective cross-sectional study was conducted using descriptive data from medical records at a tertiary hospital in Jazan Province. Records of patients diagnosed with rickets between January 2010 and December 2020 were analyzed. Symptomatic rickets cases from pediatric clinics were included, and diagnoses were based on biochemical and clinical tests. Risk factors were assessed using patient medical records. Data were analyzed using percentages, mean, and standard deviation. Results The study included 84 patients with rickets (53 females and 31 males), primarily between 11-18 years old. The mean body mass index (BMI) of the participants was 21.21. The most common risk factor was nutritional deficiencies, including vitamin D deficiency or calcium deficiency, with 75 patients reporting a family history of vitamin D deficiency. The children had limited sunlight exposure and low levels of calcium and vitamin D. Malnutrition was identified as the highest risk factor for rickets in the study population. Conclusion Nutritional rickets appears to be prevalent in the Jazan Province, emphasizing the need for government organizations to address this preventable disease. Adequate sun exposure and recommended dietary vitamin D intake are crucial to prevent rickets, as this study detected inadequate levels of calcium and vitamin D in children. National studies are required to further identify risk factors and develop appropriate strategies.
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Affiliation(s)
- Hussam Darraj
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Khalid M Hakami
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Rawan Maghrabi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Nawaf Bakri
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | | | - Abdellh A Names
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Ahmed Akkur
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Maram Sayegh
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Asma Alhazmi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Saad M Khubrani
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Gassem Gohal
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Amro H Alomar
- King Fahad Central Hospital, Ministry of Health, Jazan, 85534, Saudi Arabia
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15
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Zheng H, Xie X, Ling H, You X, Liang S, Lin R, Qiu R, Hou H. Transdermal drug delivery via microneedles for musculoskeletal systems. J Mater Chem B 2023; 11:8327-8346. [PMID: 37539625 DOI: 10.1039/d3tb01441j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
As the population is ageing and lifestyle is changing, the prevalence of musculoskeletal (MSK) disorders is gradually increasing with each passing year, posing a serious threat to the health and quality of the public, especially the elderly. However, currently prevalent treatments for MSK disorders, mainly administered orally and by injection, are not targeted to the specific lesion, resulting in low efficacy along with a series of local and systemic adverse effects. Microneedle (MN) patches loaded with micron-sized needle array, combining the advantages of oral administration and local injection, have become a potentially novel strategy for the administration and treatment of MSK diseases. In this review, we briefly introduce the basics of MNs and focus on the main characteristics of the MSK systems and various types of MN-based transdermal drug delivery (TDD) systems. We emphasize the progress and broad applications of MN-based transdermal drug delivery (TDD) for MSK systems, including osteoporosis, nutritional rickets and some other typical types of arthritis and muscular damage, and in closing summarize the future prospects and challenges of MNs application.
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Affiliation(s)
- Haibin Zheng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Xuankun Xie
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Haocong Ling
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Xintong You
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Siyu Liang
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Rurong Lin
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Renjie Qiu
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
| | - Honghao Hou
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China.
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16
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Patel R, Reynolds T, Swartz J. Nutritional rickets masquerading as spinal muscular atrophy type III. Neuromuscul Disord 2023; 33:106-109. [PMID: 37625970 DOI: 10.1016/j.nmd.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
Muscle atrophy, weakness, and loss of ambulation in the pediatric population are signs of progressive neuromuscular diseases. Rapid identification of such diseases is important to prevent further progression. In pediatric neurology, it is well understood to include neuromuscular disorders in the differential for such presentations. We report a case of severe nutritional rickets that mimicked the presentation of spinal muscular atrophy type III and discuss the importance of including rickets in the differential for muscle atrophy and loss of ambulation. A 33-month-old African American boy with several months of gait abnormality was referred to outpatient neurology. The initial diagnostic evaluation focused primarily on neuromuscular disorders, specifically SMA type III, given the absence of reflexes on examination and the history of prior ambulation. After an unfruitful genetic workup, it was elucidated that the child had very poor dietary intake and minimal sun exposure causing nutritional rickets that improved with intervention.
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Affiliation(s)
- Rutvi Patel
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Thomas Reynolds
- Department of Pediatric Neurology, Maine Medical Center, Barbara Bush Children's Hospital, Portland, ME
| | - Jonathan Swartz
- Department of Pediatric Endocrinology, Maine Medical Center, Barbara Bush Children's Hospital, Portland, ME
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17
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Bharill S, Wu M. Hypocalcemia and Hypercalcemia in Children. Pediatr Rev 2023; 44:533-536. [PMID: 37653129 PMCID: PMC11144013 DOI: 10.1542/pir.2022-005578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Sonum Bharill
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
| | - Malinda Wu
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore (MD), USA
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18
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Cannalire G, Pilloni S, Esposito S, Biasucci G, Di Franco A, Street ME. Alkaline phosphatase in clinical practice in childhood: Focus on rickets. Front Endocrinol (Lausanne) 2023; 14:1111445. [PMID: 36817604 PMCID: PMC9931734 DOI: 10.3389/fendo.2023.1111445] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Serum alkaline phosphatase (ALP) and its isoenzymes reflect bone metabolism: ALP increases the ratio of inorganic phosphate to pyrophosphate systemically and facilitates mineralization as well as reduces extracellular pyrophosphate concentration, an inhibitor of mineral formation. On the contrary, low ALP activity is associated with reduction of bone turnover. ALP includes four isoenzymes depending on the site of tissue expression: intestinal ALP, placental ALP, germ cell ALP and tissue nonspecific ALP or liver/bone/kidney ALP. The bone isoenzyme (B-ALP) is involved in bone calcification and is a marker of bone turnover as a result of osteoblastic activity. ALP and its isoenzymes are crucial in the diagnostic process of all the forms of rickets.The most common cause of rickets is vitamin D nutritional deficiency. The aim of this review is to update on the role played by ALP serum concentrations as a relevant marker in thediagnosis and treatment of rickets. Indeed, the diagnosis of rickets is based on its clinical, radiological and laboratory characteristics. An elevated ALP level is one of the markers for the diagnosis of rickets in children, though it is also associated with bone formation process. ALP is also useful for the differentiation between rickets and other disorders that can mimic rickets because of their clinical and laboratory characteristics, and, together with other biochemical markers, is crucial for the differential diagnosis of the different forms of rickets. Age, severity and duration of rickets may also modulate ALP elevation. Finally, ALP measurements are useful in clinical and therapeutic follow-up.
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Affiliation(s)
- Giuseppe Cannalire
- Pediatrics and Neonatology Unit, University of Parma, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Simone Pilloni
- Unit of Pediatrics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Susanna Esposito
- Unit of Pediatrics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, University of Parma, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Giacomo Biasucci,
| | - Anna Di Franco
- Department of Laboratory Medicine, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Maria Elisabeth Street
- Unit of Pediatrics, Department of Medicine and Surgery, University of Parma, Parma, Italy
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19
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Perry MA, Gowland RL. Compounding vulnerabilities: Syndemics and the social determinants of disease in the past. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:35-49. [PMID: 36215930 DOI: 10.1016/j.ijpp.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This article explores the theory and utility of a syndemic approach for the study of disease in the past. Syndemic principles are examined alongside other theoretical developments within bioarchaeology. Two case studies are provided to illustrate the efficacy of this approach: Tuberculosis and vitamin D deficiency in 18th and 19th century England, and malaria and helminth infections in Early Medieval England. MATERIALS Public health studies of present syndemics, in addition to published bioarchaeological, clinical and social information relating to the chosen case studies. METHODS The data from these two historical examples are revisited within a syndemic framework to draw deeper conclusions about disease clustering and heterogeneity in the past. RESULTS A syndemic framework can be applied to past contexts using clinical studies of diseases in a modern context and relevant paleopathological, archaeological, and historical data. CONCLUSIONS This approach provides a means for providing a deeper, contextualised understanding ancient diseases, and integrates well with extant theoretical tools in bioarchaeology SIGNIFICANCE: Syndemics provides scholars a deep-time perspective on diseases that still impact modern populations. LIMITATIONS Many of the variables essential for a truly syndemic approach cannot be obtained from current archaeological, bioarchaeological, or historical methods. SUGGESTIONS FOR FURTHER RESEARCH More detailed and in-depth analysis of specific disease clusters within the past and the present, which draws on a comprehensive analysis of the social determinants of health.
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Affiliation(s)
- Megan A Perry
- Department of Anthropology MS 568, East Carolina University, Greenville, NC 27858, USA.
| | - Rebecca L Gowland
- Department of Archaeology, Durham University, South Road, Durham DH1 3LE, UK.
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20
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Yi C, Xu J, He J, Zhang X, Zhang X, Huang J. Lifelong deformities in an adult caused by vitamin D‑dependent rickets type 1A: A case report. Exp Ther Med 2022; 24:762. [PMID: 36561972 PMCID: PMC9748631 DOI: 10.3892/etm.2022.11698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Vitamin D-dependent rickets (VDDR) type 1A is a rare autosomal recessive disorder caused by cytochrome P450 family 27 subfamily B member 1 (CYP27B1) mutations and can lead to deficiencies in 1α-hydroxylase activity. The present study describes the case of a 39-year-old male patient who presented with rickets and deformities of limbs. Blood biochemical analysis revealed hypocalcemia and high serum parathyroid hormone (PTH) levels. Whole-exome Sanger sequencing using peripheral venous blood of this patient and his parents revealed exon1 c.182T>C, a novel mutation. Through physical examination, laboratory tests, imaging including lower limbs and lumbar spine X-ray and pelvis CT scan, and genetic testing, the patient was diagnosed with VDDR-1A. Following 1 month of treatment with 0.5 µg 1,25-dihydroxy-vitamin D3 twice daily and 0.6 g calcium carbonate once daily, follow-up examinations revealed that the patient's PTH and serum calcium levels had returned to normal. As the patient was diagnosed in his adulthood and missed the optimal treatment period, he developed irreversible deformities. If VDDR-1A can be diagnosed during infancy and childhood, skeletal deformities may be prevented. Therefore, the present report supports the proposal of early genetic sequencing in children with calcium deficiencies for the early diagnosis of rare diseases such as VDDR-1A, -1B and -2A and hereditary hypophosphatemic rickets. Since VDDR-1A diagnosed in adults is rare, the present case may provide clinicians with further insights into the characteristics of this rare disease.
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Affiliation(s)
- Caihong Yi
- Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Juan Xu
- Department of Endocrinology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Jiangping He
- Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Xiaofang Zhang
- Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Xianfeng Zhang
- Department of Endocrinology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China,Correspondence to: Dr Jiao Huang, Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, P.R. China
| | - Jiao Huang
- Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China,Correspondence to: Dr Jiao Huang, Department of Rheumatology and Immunology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, P.R. China
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21
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Muacevic A, Adler JR. A Case Report of Rickets Due to Severe Nutritional Deficiencies. Cureus 2022; 14:e30095. [PMID: 36381909 PMCID: PMC9642367 DOI: 10.7759/cureus.30095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/23/2022] Open
Abstract
A 19-month-old boy presented to the general pediatric clinic with delayed development and multiple nutritional deficiencies, after being exclusively breastfed up to the age of nine months without vitamin D supplementation. Upon examination, imaging studies, and lab tests, the patient was diagnosed with nutritional rickets. The management included supplementation of cholecalciferol, ferrous sulfate, calcium carbonate, and multivitamin drops to support his diet, and was encouraged to follow a healthy balanced diet. Upon follow-up at the age of 20 months, the patient showed slight improvement and was able to walk, while at 22 months, the patient was developmentally up to age, and had a good appetite with a slight increase in weight. Despite the high incidence of nutritional deficiencies, there is still a lack of awareness and late presentations of such cases, which can lead to complications if not detected early. This case demonstrates the importance of prevention of similar cases by early education about adequate nutrition to the patients and caregivers and regular follow-ups with the general practitioner for early detection and early supplementation as required.
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22
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Zhang Y, Huang X, Li C, Zhang J, Yu X, Li Y, Zhou W, Yu F. Broad application prospects of bone turnover markers in pediatrics. J Clin Lab Anal 2022; 36:e24656. [PMID: 35949006 PMCID: PMC9459349 DOI: 10.1002/jcla.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bone turnover markers (BTMs) have been studied for application in clinical medicine. However, BTMs in children are challenging, and few studies explore these BTMs in children. The application of BTMs is complicated mainly due to pre-analytical factors, variable reference intervals of age- and sex-related BTMs for adolescents and children in different regions and laboratories. Therefore, laboratory testing of BTMs is critical for understanding pediatric bone development and metabolism, which provides additional information about bone development and diseases. METHODS Literature search was conducted using the MeSH term "child" combined with the terms that bone turnover markers such as "osteocalcin," "Procollagen type I N-terminal propeptide," "procollagen type I C-terminal propeptide," "osteocalcin," "N-terminal cross-linked telopeptide," and "C-terminal cross-linked telopeptide," Several databases including Web of Science, Google Scholar, and PubMed were searched to obtain the relevant studies. RESULTS BTMs represent the combined effects of skeletal development, growth, and remodeling in children, which can be used in clinical pediatrics to assist in the diagnosis and prognosis of bone metabolic disorders. CONCLUSION BTMs are clearly helpful for diagnosis and monitoring of bone growth and development as well as bone metabolic disorders.
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Affiliation(s)
- Yiduo Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaocui Huang
- Chengdu Jinjiang District Maternal and Child Healthcare Hospital, Chengdu, China
| | - Chao Li
- Chengdu Jinjiang District Maternal and Child Healthcare Hospital, Chengdu, China
| | - Jing Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xingnan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ye Li
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Wenjie Zhou
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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23
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Jurca CM, Iuhas O, Kozma K, Petchesi CD, Zaha DC, Bembea M, Jurca S, Paul C, Jurca AD. Effects of Burosumab Treatment on Two Siblings with X-Linked Hypophosphatemia. Case Report and Literature Review. Genes (Basel) 2022; 13:genes13081392. [PMID: 36011303 PMCID: PMC9407333 DOI: 10.3390/genes13081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
X-linked hypophosphatemia (XLH) or vitamin D-resistant rickets (MIM#307800), is a monogenic disorder with X-linked inheritance. It is caused by mutations present in the Phosphate Regulating Endopeptidase Homolog X-Linked (PHEX) gene responsible for the degradation of the bone-derived hormone fibroblast growth factor 23 (FGF23) into inactive fragments, but the entire mechanism is currently unclear. The inactivation of the gene prevents the degradation of FGF23, causing increased levels of FGF23, which leads to decreased tubular reabsorbtion of phosphorus. Clinical aspects are growth delay, limb deformities, bone pain, osteomalacia, dental anomalies, and enthesopathy. Laboratory evaluation shows hypophosphatemia, elevated alkaline phosphatase (ALP), and normal serum calcium levels, whereas parathormone (PTH) may be normal or increased and FGF23 greatly increased. Conventional treatment consists of administration of oral phosphate and calcitriol. Treatment with Burosumab, a monoclonal antibody that binds to FGF23, reducing its activity, was approved in 2018. Methods. We describe a case of two siblings, a girl and a boy, diagnosed with XLH, monitored by the Genetic Department of the County Emergency Clinical Hospital since 2019. The clinical picture is suggestive for XLH, both siblings exhibiting short stature, lower limb curvature, bone pain, marked walking weakness, and fatigue. Radiological aspects showed marked deformity of the lower limbs: genu varum in the girl, genu varum and valgum in the boy. Laboratory investigations showed hypophosphathemia, hyperphosphaturia, elevated ALP, normal PTH, and highly increased FGF23 in both. DNA analysis performed on the two siblings revealed a nonsense mutation in exone 5 of the PHEX gene: NM_000444.6(PHEX):c.565C > T (p.Gln189Ter). Results. At the age of 13½ on 7 June 2021, the two children started treatment with Burosumab in therapeutic doses and were monitored clinically and biochemically at regular intervals according to the protocol established by the Endocrinology Commission of the Romanian Health Ministry. Conclusions. The first results of the Burosumab treatment in the two siblings are extremely encouraging and suggest a favorable long-term evolution under this treatment.
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Affiliation(s)
- Claudia Maria Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Oana Iuhas
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Kinga Kozma
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Codruta Diana Petchesi
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Correspondence:
| | - Dana Carmen Zaha
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Marius Bembea
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Sanziana Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Daniel Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
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24
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Liau ZQG, Wang Y, Lin HY, Cheong CK, Gupta S, Hui JHP. Orthopedic concerns of a child with short stature. Curr Opin Pediatr 2022; 34:82-91. [PMID: 34840250 DOI: 10.1097/mop.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Pediatric short stature poses severe concerns to the patient, parents, and physicians. Management for pediatric short stature is still widely debated due to heterogenous etiological factors and treatment options. This review will address the approach to pediatric short stature, commonly within the subset of skeletal dysplasia resulting in disproportionate short stature. The following will be discussed: the etiology, clinical, and radiological evaluations, and management for pediatric short stature. RECENT FINDINGS Early recognition of short stature and appropriate referrals is shown to benefit the patient and reduce parental concern. A multidisciplinary team, comprising an orthopedic surgeon, is fundamental to provide holistic care and ensure overall good quality of life. Advancements in clinical diagnostic tools and diversified treatment modalities today provides optimism in managing pediatric short stature. SUMMARY Skeletal dysplasia can be treated with good prognosis if diagnosed and managed early. Thorough clinical, radiological, laboratory, and even genetic investigations are important to differentiate and manage various types of skeletal dysplasia. Our review will provide a comprehensive and up-to-date approach to skeletal dysplasia for pediatric orthopedic surgeons, and indications for physicians to refer patients with suspected short stature to pediatric orthopedic surgeons.
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Affiliation(s)
- Zi Qiang Glen Liau
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
| | - Yuhang Wang
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Hong-Yi Lin
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Chin Kai Cheong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Shobhit Gupta
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
| | - James Hoi Po Hui
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
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25
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Stoffers AJ, Weber DR, Levine MA. An Update on Vitamin D Deficiency in the twenty-first century: nature and nurture. Curr Opin Endocrinol Diabetes Obes 2022; 29:36-43. [PMID: 34839324 PMCID: PMC8849548 DOI: 10.1097/med.0000000000000691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Here, we review the most up-to-date understanding of the pathogenesis, prevention and treatment of vitamin D deficient rickets in children. This will include recent advances in the genetic determinants of abnormal vitamin D metabolism, with the intention of aiding clinicians with establishing the diagnosis and implementing treatment plans for children presenting with vitamin D deficiency rickets. RECENT FINDINGS Vitamin D deficiency rickets is a frequently encountered, but entirely preventable, disorder of bone mineral metabolism. Risk factors for developing vitamin D deficiency rickets include inadequate exposure to sunlight, exclusive breast feeding without vitamin D supplementation and inadequate intake of vitamin D, calcium or phosphorus. Other factors that may influence the development of vitamin D deficiency and/or rickets include genetic alterations or medications that alter vitamin D metabolism. SUMMARY Vitamin D levels in individuals are influenced by environmental factors, as well as genetic factors. A thorough understanding of these factors is critical for the evaluation and treatment of a child presenting with rickets. There remains a great need for additional research to determine ideal vitamin D status across diverse populations, and to better understand how vitamin D status affects overall health.
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Affiliation(s)
- Ashley J Stoffers
- The Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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26
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Oton-Gonzalez L, Mazziotta C, Iaquinta MR, Mazzoni E, Nocini R, Trevisiol L, D’Agostino A, Tognon M, Rotondo JC, Martini F. Genetics and Epigenetics of Bone Remodeling and Metabolic Bone Diseases. Int J Mol Sci 2022; 23:ijms23031500. [PMID: 35163424 PMCID: PMC8836080 DOI: 10.3390/ijms23031500] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
Bone metabolism consists of a balance between bone formation and bone resorption, which is mediated by osteoblast and osteoclast activity, respectively. In order to ensure bone plasticity, the bone remodeling process needs to function properly. Mesenchymal stem cells differentiate into the osteoblast lineage by activating different signaling pathways, including transforming growth factor β (TGF-β)/bone morphogenic protein (BMP) and the Wingless/Int-1 (Wnt)/β-catenin pathways. Recent data indicate that bone remodeling processes are also epigenetically regulated by DNA methylation, histone post-translational modifications, and non-coding RNA expressions, such as micro-RNAs, long non-coding RNAs, and circular RNAs. Mutations and dysfunctions in pathways regulating the osteoblast differentiation might influence the bone remodeling process, ultimately leading to a large variety of metabolic bone diseases. In this review, we aim to summarize and describe the genetics and epigenetics of the bone remodeling process. Moreover, the current findings behind the genetics of metabolic bone diseases are also reported.
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Affiliation(s)
- Lucia Oton-Gonzalez
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
| | - Chiara Mazziotta
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
- Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Rosa Iaquinta
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
- Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Elisa Mazzoni
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Riccardo Nocini
- Unit of Otolaryngology, University of Verona, 37134 Verona, Italy;
| | - Lorenzo Trevisiol
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, 37134 Verona, Italy; (L.T.); (A.D.)
| | - Antonio D’Agostino
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, 37134 Verona, Italy; (L.T.); (A.D.)
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
| | - John Charles Rotondo
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
- Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: (J.C.R.); (F.M.); Tel.: +39-0532-455536 (J.C.R.); +39-0532-455540 (F.M.)
| | - Fernanda Martini
- Department of Medical Sciences, University of Ferrara, 64/b, Fossato di Mortara Street, 44121 Ferrara, Italy; (L.O.-G.); (C.M.); (M.R.I.); (M.T.)
- Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
- Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy
- Correspondence: (J.C.R.); (F.M.); Tel.: +39-0532-455536 (J.C.R.); +39-0532-455540 (F.M.)
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27
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Thrailkill KM, Kalaitzoglou E, Fowlkes JL. Emerging therapies for the treatment of rare pediatric bone disorders. Front Pediatr 2022; 10:1012816. [PMID: 36304528 PMCID: PMC9592743 DOI: 10.3389/fped.2022.1012816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years, new therapies for the treatment of rare pediatric bone disorders have emerged, guided by an increasing understanding of the genetic and molecular etiology of these diseases. Herein, we review three such disorders, impacted by debilitating deficits in bone mineralization or cartilage ossification, as well as the novel disease-modifying drugs that are now available to treat these conditions. Specifically, we discuss asfotase alfa, burosumab-twza, and vosoritide, for the treatment of hypophosphatasia, X-linked hypophosphatemia and achondroplasia, respectively. For each skeletal disorder, an overview of the clinical phenotype and natural history of disease is provided, along with a discussion of the clinical pharmacology, mechanism of action and FDA indication for the relevant medication. In each case, a brief review of clinical trial data supporting drug development for each medication is provided. Additionally, guidance as to drug dosing and long-term monitoring of adverse events and pediatric efficacy is presented, to aid the clinician seeking to utilize these novel therapies in their practice, or to become familiar with the healthcare expectations for children receiving these medications through specialized multidisciplinary clinics. The availability of these targeted therapies now significantly augments treatment options for conditions in which past therapy has relied upon less specific, symptomatic medical and orthopedic care.
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Affiliation(s)
- Kathryn M Thrailkill
- Department of Pediatrics, University of Kentucky Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Evangelia Kalaitzoglou
- Department of Pediatrics, University of Kentucky Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington, KY, United States
| | - John L Fowlkes
- Department of Pediatrics, University of Kentucky Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington, KY, United States
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28
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Haffner D, Leifheit-Nestler M, Grund A, Schnabel D. Rickets guidance: part II-management. Pediatr Nephrol 2022; 37:2289-2302. [PMID: 35352187 PMCID: PMC9395459 DOI: 10.1007/s00467-022-05505-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
Here, we discuss the management of different forms of rickets, including new therapeutic approaches based on recent guidelines. Management includes close monitoring of growth, the degree of leg bowing, bone pain, serum phosphate, calcium, alkaline phosphatase as a surrogate marker of osteoblast activity and thus degree of rickets, parathyroid hormone, 25-hydroxyvitamin D3, and calciuria. An adequate calcium intake and normal 25-hydroxyvitamin D3 levels should be assured in all patients. Children with calcipenic rickets require the supplementation or pharmacological treatment with native or active vitamin D depending on the underlying pathophysiology. Treatment of phosphopenic rickets depends on the underlying pathophysiology. Fibroblast-growth factor 23 (FGF23)-associated hypophosphatemic rickets was historically treated with frequent doses of oral phosphate salts in combination with active vitamin D, whereas tumor-induced osteomalacia (TIO) should primarily undergo tumor resection, if possible. Burosumab, a fully humanized FGF23-antibody, was recently approved for treatment of X-linked hypophosphatemia (XLH) and TIO and shown to be superior for treatment of XLH compared to conventional treatment. Forms of hypophosphatemic rickets independent of FGF23 due to genetic defects of renal tubular phosphate reabsorption are treated with oral phosphate only, since they are associated with excessive 1,25-dihydroxyvitamin D production. Finally, forms of hypophosphatemic rickets caused by Fanconi syndrome, such as nephropathic cystinosis and Dent disease require disease-specific treatment in addition to phosphate supplements and active vitamin D. Adjustment of medication should be done with consideration of treatment-associated side effects, including diarrhea, gastrointestinal discomfort, hypercalciuria, secondary hyperparathyroidism, and development of nephrocalcinosis or nephrolithiasis.
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Affiliation(s)
- Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Pediatric Research Center, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany ,Pediatric Research Center, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andrea Grund
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany ,Pediatric Research Center, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Dirk Schnabel
- Center for Chronically Sick Children, Pediatric Endocrinology, Charitè, University Medicine, Berlin, Germany
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29
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Delsmann MM, Seist R, Stürznickel J, Schmidt FN, Mansour A, Kobelski MM, Broocks G, Peichl J, Oheim R, Praetorius M, Schinke T, Amling M, Demay MB, Stankovic KM, Rolvien T. Conductive Hearing Loss in the Hyp Mouse Model of X-Linked Hypophosphatemia Is Accompanied by Hypomineralization of the Auditory Ossicles. J Bone Miner Res 2021; 36:2317-2328. [PMID: 34523743 PMCID: PMC8688200 DOI: 10.1002/jbmr.4443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 01/10/2023]
Abstract
X-linked hypophosphatemia (XLH) is a hereditary musculoskeletal disorder caused by loss-of-function mutations in the PHEX gene. In XLH, increased circulating fibroblast growth factor 23 (FGF23) levels cause renal phosphate wasting and low concentrations of 1,25-dihydroxyvitamin D, leading to an early clinical manifestation of rickets. Importantly, hearing loss is commonly observed in XLH patients. We present here data from two XLH patients with marked conductive hearing loss. To decipher the underlying pathophysiology of hearing loss in XLH, we utilized the Hyp mouse model of XLH and measured auditory brain stem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) to functionally assess hearing. As evidenced by the increased ABR/DPOAE threshold shifts in the mid-frequency range, these measurements indicated a predominantly conductive hearing loss in Hyp mice compared to wild-type (WT) mice. Therefore, we carried out an in-depth histomorphometric and scanning electron microscopic analysis of the auditory ossicles. Quantitative backscattered electron imaging (qBEI) indicated a severe hypomineralization of the ossicles in Hyp mice, evidenced by lower calcium content (CaMean) and higher void volume (ie, porosity) compared to WT mice. Histologically, voids correlated with unmineralized bone (ie, osteoid), and the osteoid volume per bone volume (OV/BV) was markedly higher in Hyp mice than WT mice. The density of osteocyte lacunae was lower in Hyp mice than in WT mice, whereas osteocyte lacunae were enlarged. Taken together, our findings highlight the importance of ossicular mineralization for hearing conduction and point toward the potential benefit of improving mineralization to prevent hearing loss in XLH. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Maximilian M Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Seist
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Amer Mansour
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Margaret M Kobelski
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan Peichl
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mark Praetorius
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Marie B Demay
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Sodri NI, Mohamed-Yassin MS, Mohd Nor NS, Ismail IA. Rickets Due to Severe Vitamin D and Calcium Deficiency During the COVID-19 Pandemic in Malaysia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934216. [PMID: 34723934 PMCID: PMC8570386 DOI: 10.12659/ajcr.934216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Female, 22-month-old
Final Diagnosis: Nutritional rickets
Symptoms: Bowing of legs
Medication:—
Clinical Procedure:—
Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Nurul Izzah Sodri
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Batu Caves, Selangor, Malaysia
| | | | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.,Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Ilham Ameera Ismail
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Batu Caves, Selangor, Malaysia
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Koljonen L, Enlund-Cerullo M, Hauta-alus H, Holmlund-Suila E, Valkama S, Rosendahl J, Andersson S, Pekkinen M, Mäkitie O. Phosphate Concentrations and Modifying Factors in Healthy Children From 12 to 24 Months of Age. J Clin Endocrinol Metab 2021; 106:2865-2875. [PMID: 34214153 PMCID: PMC8475199 DOI: 10.1210/clinem/dgab495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Phosphate homeostasis and its modifiers in early childhood are inadequately characterized. OBJECTIVE To determine physiological plasma phosphate concentration and modifying factors in healthy infants at 12 to 24 months of age. DESIGN This study included 525 healthy infants (53% girls), who participated in a randomized vitamin D intervention trial and received daily vitamin D3 supplementation of either 10 or 30 μg from age 2 weeks to 24 months. Biochemical parameters were measured at 12 and 24 months. Dietary phosphate intake was determined at 12 months. MAIN OUTCOME MEASURES Plasma phosphate concentrations at 12 and 24 months of age. RESULTS Mean (SD) phosphate concentration decreased from 12 months (1.9 ± 0.15 mmol/L) to 24 months (1.6 ± 0.17 mmol/L) of age (P < 0.001 for repeated measurements). When adjusted by covariates, such as body size, creatinine, serum 25-hydroxyvitamin D, intact and C-terminal fibroblast growth factor 23, mean plasma phosphate was higher in boys than girls during follow-up (P = 0.019). Phosphate concentrations were similar in the vitamin D intervention groups (P > 0.472 for all). Plasma iron was associated positively with plasma phosphate at both time points (B, 0.006 and 0.005; 95% CI, 0.004-0.009 and 0.002-0.008; P < 0.001 at both time points, respectively). At 24 months of age, the main modifier of phosphate concentration was plasma creatinine (B, 0.007; 95% CI 0.003-0.011, P < 0.001). CONCLUSION Plasma phosphate concentration decreased from age 12 to 24 months. In infants and toddlers, the strongest plasma phosphate modifiers were sex, iron, and creatinine, whereas vitamin D supplementation did not modify phosphate concentrations.
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Affiliation(s)
- Laura Koljonen
- Folkhälsan Research Center, 00290 Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Maria Enlund-Cerullo
- Folkhälsan Research Center, 00290 Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Helena Hauta-alus
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
- National Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu,Finland
| | - Elisa Holmlund-Suila
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Saara Valkama
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Jenni Rosendahl
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Sture Andersson
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Minna Pekkinen
- Folkhälsan Research Center, 00290 Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Outi Mäkitie
- Folkhälsan Research Center, 00290 Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, 17176 Stockholm, Sweden
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Rickets in Children: An Update. Biomedicines 2021; 9:biomedicines9070738. [PMID: 34199067 PMCID: PMC8301330 DOI: 10.3390/biomedicines9070738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Rickets refers to a deficient mineralization of the growth plate cartilage, predominantly affecting longer bones. Despite the fact that preventive measures are available, it is still a common disease worldwide; nutritional rickets, due to vitamin D deficiency or dietary calcium inadequate intake, remains the most common form. Medical history, physical examination, radiologic features and biochemical tests are essential for diagnosis. Although recent studies suggest hypophosphatemia as the leading alteration, rickets is classically divided into two categories: calcipenic rickets and phosphopenic rickets. Knowledge of this categorization and of respective clinical and laboratory features is essential for rapid diagnosis and correct management. The aim of this review is to analyze the epidemiological, pathogenetic, clinical, and therapeutic aspects of the different forms of rickets, describing the novelties on this “long-lived” disease.
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