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0:00
Hello, everyone.
I'm Dr. Suma Uday.
A consultant in pediatric
endocrinology, diabetes, and
metabolic bone diseases at
Birmingham Women's and
Children's Hospital
in Birmingham in the UK.
I'm also an Honorary
Associate Clinical Professor
at the University of Birmingham.
Today, I'm going to talk about
nutritional rickets
and osteomalacia.
I would really like to thank HST
for inviting me to this
informative session.
0:30
Here's a brief
overview of my talk.
I'm going to be talking about
what nutritional rickets is,
and what osteomalacia is.
We will briefly touch on
vitamin D metabolism
and its pathway,
as it is really
important to understand
the various causes of
vitamin D deficiency
and also the physiologic
response to low calcium,
in order to understand
the etiologies of rickets
and manage them accurately.
I will touch on the
various causes of rickets
and osteomalacia, but
my focus will be on
nutritional rickets
and osteomalacia,
as this is the most
common cause of
rickets and
osteomalacia worldwide.
We will examine the role of
both vitamin D as well
as calcium deficiency.
I will go through some
case scenarios to explore
the clinical presentation
and management,
and no talk on
nutritional rickets and
osteomalacia will be complete
without touching on
the prevention aspect.
So we will conclude with
a focus on prevention.
1:31
What is rickets?
Rickets is the defective
mineralization
of the growth plate
cartilage and the adjacent
primary as well as
secondary spongiosa.
Now, rickets is only
seen in growing children
with open epiphyses.
At the tissue level,
rickets results from
a lack of phosphate,
and phosphate is very important
for the apoptosis
of chondrocytes.
When there is no apoptosis
of chondrocytes,
the hypertrophic chondrocytes
accumulate in the growth plates.
This is what you're seeing in
the histology image on
the left-hand side.
What you can see is
the accumulation
of hypertrophic chondrocytes,
which are all disarrayed,
and therefore, this leads
to swelling of the joints.
What you can see on the
right side figure is
a normal growth plate,
where the chondrocytes are
arranged in a very orderly manner.
These changes are
reflected on X-rays.
As you can see up here
on the radiograph,
there's swelling of the wrist
joint and also cupping,
splaying, and fraying,
which are the classic
signs of rickets.
