Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children

• Published in: Cochrane database of systematic reviews 2020-04, Vol.4 (4), p.CD012581
• Main Authors: Chibuzor, Moriam T, Graham-Kalio, Diepiriye, Osaji, Joy O, Meremikwu, Martin M
• Format: Article
• Language: English
• Subjects: Adolescent; Calcium - therapeutic use; Child; Child health; Child, Preschool; Endocrine & metabolic; Fractures, Bone - epidemiology; Fractures, Bone - prevention & control; Humans; Infant; Other Metabolic and Nutritional Disorders; Randomized Controlled Trials as Topic; Rickets - etiology; Rickets - therapy; Vitamin D - therapeutic use; Vitamin D Deficiency - complications; Vitamin D Deficiency - therapy; Vitamins - therapeutic use
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012581.pub2

Nutritional rickets is a disease which affects children, especially in low- and middle-income countries. It causes problems such as skeletal deformities and impaired growth. The most common cause of nutritional rickets is vitamin D deficiency. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. In some sunny countries, however, where children are believed to have adequate vitamin D production from exposure to ultraviolet light, but who are deficient in calcium due to low dietary intake, calcium alone has also been used in the treatment of nutritional rickets. Therefore, it is important to compare the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children living in different settings. To assess the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children. We searched CENTRAL, MEDLINE, LILACS, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search of all databases was 25 July 2019. We applied no language restrictions. We included randomised controlled trials (RCT) involving children aged 0 to 18 years with nutritional rickets which compared treatment with vitamin D, calcium or a combination of vitamin D and calcium. Two review authors independently screened the title and abstracts of all studies, extracted data and assessed the risk of bias of included studies. We resolved any disagreements by consensus or recourse to a third review author. We conducted meta-analyses for the outcomes reported by study authors. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI) and, for continuous outcomes, we calculated mean differences (MD) with 95% CIs. We assessed the certainty of the evidence of the included studies using GRADE. We identified 4562 studies; of these, we included four RCTs with 286 participants. The studies compared two or more of the following: vitamin D, calcium or vitamin D plus calcium. The number of participants randomised to receive vitamin D was 64, calcium was 102 and vitamin D plus calcium was 120. Two studies were conducted in India and two were conducted in Nigeria. None of the included studies had a low risk of bias in all domains. Three studies had a high risk of bias in at least one domain. The age of the participants ranged between six months and 14 years. The duration of follow-up ranged between 12