STUDY OF BONE HEALTH PARAMETERS IN ASYMPTOMATIC TODDLERS FROM AN URBAN SLUM IN PUNE
Borade A*, Hanumante NM**, Vaidya MV***, Momin SR****, Pillay DS*****, Damle AA******
Poona Medical Foundation Research Center, Ruby Hall Clinic, Pune.*, Poona Medical Foundation Research Center, Ruby Hall Clinic, Pune.**, Cummins college of Engineering, Pune.***, Hirabai Cowasji Jehangir Medical Research Institute, Pune.****, Hirabai Cowasji Jehangir Medical Research Institute, Pune.*****, Hirabai Cowasji Jehangir Medical Research Institute, Pune.******
Aim: To study the bone health parameters in apparently healthy toddlers (1 to 3 year olds) from he lower socio-economic class (LSC) in Pune.

Methods: Subjects concentration of calcium (Ca), Phosphate (P), alkaline phosphatase (ALP), 25-hydroxy Vitamin D (250 HD) and parathyroid hormone (PTH) were measured cross-sectional in 50 toddlers from 1-3 years of age. History was taken and clinical examination was performed. Dietary intake of calcium and phosphorous was estimated using a standard food frequency questionnaire.

Results: 51 children (M=25, F=26) with mean age of 2.4 years (SD 0.82), mean height 81.0 cm (SD 7.6), mean weight 10.0 kg. (SD 2.3) were evaluated. Four children showed evidence of rickets on physical examination. The mean daily dietary intake of Calcium was 579.2 mg (SD 59.2) which was chiefly from vegetarian sources and calcium intake from milk and other dairy products was negligible. The mean ALP was 531.8 lU/L (SD 127.7) (value are < 450 in growing children), mean ionic calcium was 0.99 mmo1/L (SD 0.05) (range 1.13-1.18 mmo1/L), mean P 1.45 mmol/L (SD 0.15) (range 0.7-1.4 mmol/1), mean PTH was 8.33 pmo1/1 (SD-6.24) (range 1.1-6.4), mean 250 OHD 50.5 ng /ml (SD 25.04) (range 10-50). The serum ionic calcium of all 51 children (100%) was below the reference rage, while the 250 OHD was normal. 25 out of 51 (49%) of toddlers had PTH above the upper end of the reference range while the P levels were above the upper end of the reference range in 27 (52.9%) subjects.

Conclusion: We speculate that the high incidence of hypocalcaemia and secondary hyperparathyroidism among our population resulted from low dietary Ca intake from dairy sources. The findings of this study suggest that a number of toddlers have hypocalcaemia and provision of calcium at this stage may prevent florid rickets.
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