Anticonvulsant Induced Rickets - Contents | Cases | Comments | Bibliography

Anticonvulsant Induced Rickets

Comments

As an orthopaedic surgeon I thought that this case was extremely rare as we come across this type of problem so infrequently. However, reviewing the literature for this site suggested a very different picture. High incidences of rickets (around 4%) were reported in institutionalized epileptic children and numerous studies suggested that abnormalities of vitamin D metabolism are present throughout that population. Increased risk factors appear to include non-ambulatory status, poor diet and lack of exposure to sunlight - all presumably correlated with the severity of mental retardation. Various papers suggest that vit D supplements should be routinely offered to the population of mentally retarded, epileptic, poorly ambulant children. Osteomalacia in the older institutionalized epileptic patient is also common.

There is little in the orthopaedic literature but a study by Lee et al in Detroit shows that pathological fractures in this population are common. They suggest that vitamin D levels should be measured in all such children with fractures and that non-accidental injury should be ruled out where the vitamin D level is normal!