Calcified Tissue International

, Volume 76, Issue 6, pp 412–418 | Cite as

Severe Bone Deformities in Young Children From Vitamin D Deficiency and Fluorosis in Bihar-India

Article

Abstract

A case-control study was undertaken to understand the etiopathology of the bone deformities among young children in a fluoride-affected village of the Bihar State. Two villages were selected: one village with high fluoride in drinking water (7.9 ± 4.15 ppm), and the other village with normal levels of fluoride (0.6 ± 0.31 ppm) as the control village. The source of drinking water was bore wells in both the villages. Two hundred and forty subjects from 54 households (HHs) of the high-fluoride village (HFV) and 1443 subjects from 197 HHs of the control village were selected for the study. Dental mottling (DM) was observed in 50% and skeletal deformities of various forms were observed in 20% of the total population of HFV, whereas, in the control village, DM was 6% and skeletal deformities were absent. The prevalence of both, DM and skeletal deformities was high in the younger age group of 1.5 to 14 years. Genu valgum, genu varum, bowing of tibia, saber shin, and widening of the lower ends of long bones at the wrist were the typical skeletal deformities observed among affected children in the HFV. X-rays of the children with deformities revealed varying degrees of bending of bones and enlargement of epiphyseal ends of metaphyses with fraying of bone and ligamental calcification. A survey indicated significantly low calcium and high phosphorus intake among the population of the HFV as compared to that of the control village, possibly resulting from low intake of milk and high intake of potatoes, respectively. The mean urinary fluoride level was significantly higher in the children of the HPV, both with and without deformities, as compared to that of the control village. The mean serum 25 OHD3 (25 HYDROXY Vitamin D) and calcium levels were significantly lower and alkaline phophatase activity was significantly higher among the children with deformities as compared to those without deformities from the HFV and the control village. Serum intact parathyroid hormone (IPTH) levels were high in children both with and without deformities in the HFV as compared to those in the control village. No significant differences were observed in the concentration of serum and urinary creatinine, and Cu, and Mg levels between the HFV and the control village. It can be concluded that some of the children from the HFV manifested severe bone deformities (rickets), which were confirmed by the existence of low serum calcium and vitamin D levels.

Keywords

Hyperparathyroidism Rickets Osteoblasts Osteosclerosis Alkaline phosphotase 

References

  1. 1.
    Susheela, AK 1999Fluorosis management program in IndiaCurr Sci7712501255Google Scholar
  2. 2.
    Michel AA (1972) The impact of Modern Irrigation Technology in the Indus and Helmand Basins of South-West Asia in The Careless Technology. Farvar, MT, Milton, Jp (eds.), p 257Google Scholar
  3. 3.
    Krishnamachari, KAVR, Sivakumar, B 1976Endemic genu valgum a new dimension to the fluorosis problem in IndiaFluoride9185200Google Scholar
  4. 4.
    Krishnamachari, KAVR 1976Further observation on the syndrome of endemic genu valgum of South IndiaInd J Med Res64284291Google Scholar
  5. 5.
    Garcia-Pascuel, B, Peytermann, A, Courvoisier, B, Lawson, DE 1976A simplified competetive protein binding assay for 25-hydroxycalciferolClin Chim Acta6899105CrossRefPubMedGoogle Scholar
  6. 6.
    Frank, B Hu, Eric, R, Stephanie, A, Smith-Warner, , Diane Feshkanich, ,  et al. 1999Reproducibility and validity of dietary patterns assessed with a food frequency questionnaireAm J Clin Nutr69243249PubMedGoogle Scholar
  7. 7.
    Gopalan C, Ramasastry BV, Balsasubramanyam SC, Narsinga Rao BS, Deosthale YG, Panth KC (1990) Nutritive value of Indian Foods, National Institute of Nutrition (NIN), Indian Council of Medical Research (ICMR). NIN, Hyderabad, IndiaGoogle Scholar
  8. 8.
    Expert group of Indian Council of Medical Research, Recommended Dietary Intakes for Indians, ICMR (1981). ICMR, New Delhi, IndiaGoogle Scholar
  9. 9.
    Chakma, TP, Rao, V, Singh, SB, Tiwary, RS 2000Endemic genu valgum and other bone deformities in two villages of Mandla district in central IndiaFluoride33187195Google Scholar
  10. 10.
    Srivastava, RN, Gill, DS, Maudgil, A, Menon, RK, Thomas, M, Andona, PD 1989Normal ionized calcium, parathyroid hyper secretion and elevated osteocalcin and family with fluorosisMetabolism38120124CrossRefPubMedGoogle Scholar
  11. 11.
    Moudgil, A, Srivastava, RN, Vasudev, A, Bagga, A, Gupta, A 1986Fluorosis with crippling skeletal deformitiesIndian Pediatr23769773Google Scholar
  12. 12.
    Teotia, M, Teotia, SPS, Singh, KP 2000Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in IndiaInd J Pediatr65371381Google Scholar
  13. 13.
    Krishnamachari, KAVR, Kamala, K 1974An epidemiological study of the syndrome of genu valgum among residents of endemic areas for fluorosis in andhra pradeshInd J Med Res6214151423Google Scholar
  14. 14.
    Lennart, K, Ronald, RM 1998Fluoride and alkaline phosphataseFluoride31177182Google Scholar
  15. 15.
    Krishnamachari, KAVR, Kamala, K 1973Genu valgum and osteoporosis in area of endemic fluorosisLancetii877879CrossRefGoogle Scholar
  16. 16.
    Henry, HL, Norman, AW 1984Vitamin D metabolism and biological actionsAnnu Rev Nutr4493520CrossRefPubMedGoogle Scholar
  17. 17.
    Fukase, M, Birge, SJ, Rifas, L, Avioli, LV, Chase, LR 1982Regulation of 25 hydroxy vitamin D3 1-hydroxylase in serum-free mono layer culture of mouse kidneyEndocrinology11010731075PubMedGoogle Scholar
  18. 18.
    Boyel, IT, Gray, RW, Deluca, HF 1971Regulation by calcium of in vitro synthesis of 1,25-dihydroxy cholecalciferol and 24-25 dihydroxy cholecalciferolProc Natl Acad Sci USA6821312135PubMedGoogle Scholar
  19. 19.
    Henry, H 1985Parathyroid modulation of 25-hydroxy vitamin D3 metabolism by cultured chick kidney cells is mimicked and enhanced by ForskolinEndocrinology116503510PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  1. 1.National Institute of Nutrition (ICMR) Jamia Osmania P.O.HyderabadIndia

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