Rickets of Vitamin D Deficiency Children's Hospital, Zhejiang University School of Medicine JIE SHAO THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Rickets of Vitamin D Deficiency Children’s Hospital, Zhejiang University School of Medicine JIE SHAO
Introduction Rickets was described medically in the mid-17th century by Whistler,Boate and Glisson and other fellows of the Royal College of Physicians,London Vitamin D-deficiency rickets is an important disease of childhood in China.It occurs in all regions but is more prevalent in the north THE CHILDREN'S HOSPITAL MEDICINE 浙江大学医学院附属儿童医院
Introduction Rickets was described medically in the mid-17th century by Whistler, Boate and Glisson and other fellows of the Royal College of Physicians, London Vitamin D-deficiency rickets is an important disease of childhood in China. It occurs in all regions but is more prevalent in the north
Definition The bone matrix (osteoid)of the growing bone is inadequately mineralized,giving rise to the clinical features The peak age at which rickets is most prevalent is 3-24 months THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Definition The bone matrix (osteoid) of the growing bone is inadequately mineralized, giving rise to the clinical features The peak age at which rickets is most prevalent is 3-24 months
Source of vitamin D >Endogenous ultraviolet light 7-dehydrocholesterolcholecalciferol(vitD3) Exogenous diet,primarily Liver,kidney of animal and yolk THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Source of vitamin D ¾ Endogenous 7-dehydrocholesterol cholecalciferol(vitD3) ¾ Exogenous diet, primarily Liver , kidney of animal and yolk ultraviolet light
Metabolism of vitamin D Mwwwwugwgwww D3 25-hydroxylase THE CHILDREN'S ZHEJIANG UNIVERSITY SCHOOL OF MEDICIN 一、一一、洗附属儿童医院
Metabolism of vitamin D
Regulation of vitamin D Growth hormone 1,25- (一) (OH)2D3 Insulin (+) 1,25- (OH)2D3 (+) PTH Phosphate Estrogen Calcium THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Regulation of vitamin D Growth hormone Insulin Estrogen （＋） 1,25- (OH) 2 D 3 1,25- (OH) 2 D 3 Calcium Phosphat e （＋） （－） PTH
Function of vitamin D >1,25-(OH,D,(约85%与DBP结合，15%与白蛋白结 合) 0.4%以游离形式存在 >Increase the synthesize of Calcium-binding protein (CaBP) Promote Ca,P absorption by renal tubules >Facilitating mineralization of the bone >Preventing ricket,osteomalacia and osteoporosis >Maintain Ca.P levels THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Function of vitamin D ¾ 1,25-(OH) 2 D 3 ( 约85％与DBP结合，15％与白蛋白结 合） 0.4 ％ 以游离形式存在 ¾ Increase the synthesize of Calcium-binding protein （CaBP ） ¾ Promote Ca,P absorption by renal tubules ¾ Facilitating mineralization of the bone ¾ Preventing ricket, osteomalacia and osteoporosis ¾ Maintain Ca,P levels
Etiology 1.Decrease in sunshine exposure Increased urbanization:more pollution Less outdoor activity time for children Increased sunscreen use >Use of clothing providing minimal skin exposure to the sun owing to social and religious reasons >Winter-Ultraviolet light THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
1、Decrease in sunshine exposure ¾ Increased urbanization: more pollution ¾ Less outdoor activity time for children ¾ Increased sunscreen use ¾ Use of clothing providing minimal skin exposure to the sun owing to social and religious reasons ¾ Winter - Ultraviolet light Etiology Etiology
2,Decrease in dietary vitamin D >Cow milk:the proportion of Ca:P(1.2:1) >use of non-vitamin D-fortified juice or milk >Increase of vegan or other restrictive diets >Breast feeding:Vit Dwithout vitamin D supplementation after 6 months of age,such as yolk(120-140IU/g), liver,formula THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
2、Decrease in dietary vitamin D ¾ Cow milk: the proportion of Ca:P (1.2:1) ¾ use of non–vitamin D–fortified juice or milk ¾ Increase of vegan or other restrictive diets ¾ Breast feeding : Vit D< 40 IU/L ，Ca:P (2:1) ¾ without vitamin D supplementation after 6 months of age， such as yolk (120-140IU/g), liver, formula
3、Rapid growi边 >Preterm infants >Low-birthweight infant 4、Disease >Hepatic and gastroenteric Infant Hepatitis Syndrome Congenital Biliary Stenosis Congenital Biliary Atresia Chronic Diarrhea >Renal diseases THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
3、Rapid growth ¾ Preterm infants ¾ Low-birthweight infant 4、Disease ¾ Hepatic and gastroenteric Infant Hepatitis Syndrome Congenital Biliary Stenosis Congenital Biliary Atresia Chronic Diarrhea ¾ Renal diseases