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Treatment of Vitamin-D Resistant Rickets A LONG-TERM EVALUATION OF ITS EFFECTIVENESS
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From the St. Louis Unit of the Shriners' Hospital for Crippled Children, the Department of Surgery and the Department of Internal Medicine, Washington University School of Medicine, St. Louis
1964 by The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 1964 Jul 01;46(5):965-977
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The results of treatment of twenty children with vitamin-D resistant rickets with massive daily doses of vitamin D have been presented. In these children we were unable to prevent the recurrence of deformities or to restore a normal growth pattern. This failure parallels the inability of this therapy to correct the low serum phosphorus without producing marked hypercalcemia and renal insufficiency. According to roentgenographic evidence, healing of the rickets can he induced by large doses of vitamin D, but cure of the disease cannot be achieved in this manner. Currently, we are continuing with massive doses of vitamin D and also bracing the extremities until the children are five or six years of age and can cooperate in taking vitamin D. The use of multiple osteotomies over an intramedullary nail may be helpful in reducing the recurrence of the deformities.

Data have been presented demonstrating that, during a calcium infusion, the renal tubules in patients with vitamin-D resistant rickets are capable of normal phosphate transport. It is therefore suggested that the low serum phosphorus and hyperphosphaturia characteristic of the disease are caused by extrarenal factors of which secondary hyperparathyroidism is the most important.

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    rickets ; vitamin d
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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