The regulation of vitamin-D dosage by means of twenty-four-hour urinary calcium values is relatively simple and requires no unusual laboratory procedures. If carefully applied, partial roentgenographic healing can occur and this status can be maintained permitting a nearly normal rate of growth and avoidance of hypervitaminosis D.
The importance of avoiding hypervitaminosis D is stressed. Repeated swings from hypovitaminosis to hypervitaminosis D merely alternates one disturbance of bone metabolism for another; both deplete the skeleton. Adequate therapy must maintain the child as nearly normal as possible, despite the chronic hypophosphatemia.
Under adequate vitamin-D therapy the leg deformities may improve but in our cases did not correct completely. Surgical correction is usually necessary. However, this is indicated only after regulation with adequate vitamin-D therapy. The deformities often recur if the therapy is interrupted or is grossly inadequate.
The parents are always warned that this is a chronic metabolic disease which must be followed throughout life and is especially hazardous during growth for the prevention of deformities and the maintenance of a normal rate of growth, but may recur in later years. The general practitioner should also be informed that children whose rickets does not heal promptly with customary doses of vitamin D are not suffering from simple rickets and should be referred to clinics where their disease can be treated and followed adequately.