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cannot be ensured. Various dose schedules have been used and are shown in
the table given below.Intensive phase therapy Maintenance therapy
1,00,000 IU of vitamin D 2 orally every 2hours for 12h (total dose
6,00,000)400 IU/day after 3 monthsor
1,50,000–300,000 IU orally as a single dose 400 IU/day after 3 months
or
6,00,000 IU intramuscularly as a single dose 400 IU/day after 3 months- How to monitor a child with rickets on vitamin D therapy?
After initiation of therapy, children with rickets should be monitored for efficacy
and adverse effects of therapy. After 1 month of therapy, calcium profile (serum
calcium, albumin, phosphorus, and alkaline phosphatase) should be monitored.
The earliest response is improvement in serum phosphorus, which can be seen as
early as 1–2 weeks, accompanied with rise in alkaline phosphatase. At 3 months
of therapy, calcium profile, serum 25(OH)D, iPTH, urine calcium/creatinine
ratio, and radiology should be performed. Optimal therapy usually results in
resolution of biochemical and radiological abnormalities within 3 months. These
patients should be followed at periodic intervals of 6 months, and 25(OH)D level
must be estimated at 1 year, and annually thereafter.- What are the radiological features of healing rickets?
After initiation of therapy, a thin radiolucent line (a line of provisional calcifica-
tion) appears adjacent to the metaphyseal end of long bone by 2–3 weeks,
which represents calcification of chondroid matrix in the calcification zone of
epiphyseal growth plate. This is followed by progressive mineralization of
“cupping defect,” which represents ossification of osteoid matrix present
between line of provisional calcification and metaphyseal end of long bone.
Slight cupping may remain as stigma of old rickets. The resolution of radiologi-
cal abnormalities occurs within 3 months of optimal therapy (Fig. 5.12).Healing ricketsZone of preparatory
calcificationCalcification proceeding
towards metaphyseal endFig. 5.12 Healing rickets
5 Rickets–Osteomalacia