Severe Bone Deformities in Young Children From Vitamin D Deficiency and Fluorosis in Bihar-India
- 356 Downloads
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.
KeywordsHyperparathyroidism Rickets Osteoblasts Osteosclerosis Alkaline phosphotase
The authors thank the “Indian Council of Medical Research” for funding the study. The authors also acknowledge the encouragement and guidance given by Dr Gafoorunissa. Dr. Vijayaraghavan, Dr. V. Ramesh Bhat of the National Institute of Nutrition. Thanks also to Mr. Shanker Rao, Ajay Kumar and Dr. N. Balakrishna for their technical and statistical support. Special thanks to Dr. Kakarla Subbarao, Radiologist and Director, Nizam Institute of Medical Sciences for his valuable his valuable comments on X-rays.
- 1.Susheela, AK 1999Fluorosis management program in IndiaCurr Sci7712501255Google Scholar
- 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.Krishnamachari, KAVR, Sivakumar, B 1976Endemic genu valgum a new dimension to the fluorosis problem in IndiaFluoride9185200Google Scholar
- 4.Krishnamachari, KAVR 1976Further observation on the syndrome of endemic genu valgum of South IndiaInd J Med Res64284291Google Scholar
- 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.Expert group of Indian Council of Medical Research, Recommended Dietary Intakes for Indians, ICMR (1981). ICMR, New Delhi, IndiaGoogle Scholar
- 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
- 11.Moudgil, A, Srivastava, RN, Vasudev, A, Bagga, A, Gupta, A 1986Fluorosis with crippling skeletal deformitiesIndian Pediatr23769773Google Scholar
- 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.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.Lennart, K, Ronald, RM 1998Fluoride and alkaline phosphataseFluoride31177182Google Scholar