Treatment of Nutritional and Calcipenic Rickets in Patients Under 18 Years
Clinical Scenario
This protocol covers paediatric patients under 18 years of age presenting with nutritional rickets in the calcipenic form. Because the diet of children and adolescents with nutritional rickets is typically low in both vitamin D and calcium, combined supplementation is the cornerstone of management — with the specific approach guided by the patient's age group.
Treatment Approach (partial overview)
Management involves vitamin D supplementation — using ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) — together with oral calcium. The regimen is stratified by age group, and an alternative route may be considered in cases of non-adherence. In patients with symptomatic hypocalcaemia, additional parenteral intervention is required. The complete age-stratified dosing, duration, and decision algorithm are in the full protocol.
Treatment Goals
- Normalisation of serum calcium and phosphate levels, and significant decrease in PTH levels within 3 weeks
- Normalisation of ALP levels within several months
References
DOI: 10.1007/s00467-022-05505-5
- Combined treatment is recommended, as the diet of children and adolescents with nutritional rickets is usually low in both vitamin D and calcium.
- Patients should be treated with ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) at a minimal dose of 2000 IU (50 μg) per day in conjunction with 500 mg oral calcium per day, either as a dietary intake or supplements, for a minimum of 3 months.
- Oral vitamin D treatment is preferable, as it was shown to restore 25(OH)D levels more rapidly than intramuscular treatment, at least in adults.
- Intravenous calcium gluconate should be given in patients with symptomatic hypocalcemia until normalization of serum calcium levels.
- Depending on the severity of rickets, vitamin D and calcium supplementation may already result in normalization of serum calcium and phosphate levels and a significant decrease in PTH levels within 3 weeks, whereas normalization of ALP levels may take several months.
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