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. 2020 Apr 17;4(4):CD012581.
doi: 10.1002/14651858.CD012581.pub2.

Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children

Moriam T Chibuzor  1 , Diepiriye Graham-Kalio  2 , Joy O Osaji  3 , Martin M Meremikwu  4
Affiliations

Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children

Moriam T Chibuzor et al. Cochrane Database Syst Rev. .

Abstract

Background: Nutritional rickets is a disease which affects children, especially in low- and middle-income countries. It causes problems such as skeletal deformities and impaired growth. The most common cause of nutritional rickets is vitamin D deficiency. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. In some sunny countries, however, where children are believed to have adequate vitamin D production from exposure to ultraviolet light, but who are deficient in calcium due to low dietary intake, calcium alone has also been used in the treatment of nutritional rickets. Therefore, it is important to compare the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children living in different settings.

Objectives: To assess the effects of vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children.

Search methods: We searched CENTRAL, MEDLINE, LILACS, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search of all databases was 25 July 2019. We applied no language restrictions.

Selection criteria: We included randomised controlled trials (RCT) involving children aged 0 to 18 years with nutritional rickets which compared treatment with vitamin D, calcium or a combination of vitamin D and calcium.

Data collection and analysis: Two review authors independently screened the title and abstracts of all studies, extracted data and assessed the risk of bias of included studies. We resolved any disagreements by consensus or recourse to a third review author. We conducted meta-analyses for the outcomes reported by study authors. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI) and, for continuous outcomes, we calculated mean differences (MD) with 95% CIs. We assessed the certainty of the evidence of the included studies using GRADE.

Main results: We identified 4562 studies; of these, we included four RCTs with 286 participants. The studies compared two or more of the following: vitamin D, calcium or vitamin D plus calcium. The number of participants randomised to receive vitamin D was 64, calcium was 102 and vitamin D plus calcium was 120. Two studies were conducted in India and two were conducted in Nigeria. None of the included studies had a low risk of bias in all domains. Three studies had a high risk of bias in at least one domain. The age of the participants ranged between six months and 14 years. The duration of follow-up ranged between 12 weeks and 24 weeks. Two studies compared vitamin D to calcium. There is low-certainty evidence that, at 24 weeks' follow-up, calcium alone improved the healing of rickets compared to vitamin D alone (RR 3.26, 95% CI 1.59 to 6.69; P = 0.001; 1 study, 71 participants). Comparing vitamin D to calcium showed no firm evidence of an advantage or disadvantage in reducing morbidity (fractures) (RR 0.27, 95% CI 0.03 to 2.32; P = 0.23; 1 study, 71 participants; very low-certainty evidence). Adverse events were not reported. Two studies compared vitamin D plus calcium to vitamin D at 12 or 24 weeks. Vitamin D plus calcium improved healing of rickets compared to vitamin D alone at 24 weeks' follow-up (RR 3.06, 95% CI 1.49 to 6.29; P = 0.002; 1 study, 75 participants; low-certainty evidence). There is no conclusive evidence in favour of either intervention for reducing morbidity (fractures) (RR 0.24, 95% CI 0.03 to 2.08; P = 0.20; 1 study, 71 participants; very low-certainty evidence) or adverse events (RR 4.76, 95% CI 0.24 to 93.19; P = 0.30; 1 study, 39 participants; very low-certainty evidence). All four included studies compared vitamin D plus calcium to calcium at different follow-up times. There is no conclusive evidence on whether vitamin D plus calcium in comparison to calcium alone improved healing of rickets at 24 weeks' follow-up (RR 1.17, 95% CI 0.72 to 1.90; P = 0.53; 2 studies, 140 participants; very low-certainty evidence). Evidence is also inconclusive for morbidity (fractures) (RR 0.89, 95% CI 0.06 to 13.76; P = 0.94; 1 study, 72 participants; very low-certainty evidence) and adverse events (RR 4.29, 0.22 to 83.57; P = 0.34; 1 study, 37 participants; very low-certainty evidence). Most of the evidence in the review is low or very low certainty due to risk of bias, imprecision or both. None of the included studies assessed all-cause mortality, health-related quality of life or socioeconomic effects. One study assessed growth pattern but this was not measured at the time-point stipulated in the protocol of our review (one or more years after commencement of therapy).

Authors' conclusions: This review provides low-certainty evidence that vitamin D plus calcium or calcium alone improve healing in children with nutritional rickets compared to vitamin D alone. We are unable to make conclusions on the effects of the interventions on adverse events or morbidity (fractures).

PubMed Disclaimer

Conflict of interest statement

MC: This review was partly funded by a grant from Department for International Development (DFID) through UKAid funding provided to the Effective Health Care Research Consortium at the Liverpool School of Tropical Medicine.

DG: none known.

JO: none known.

MM: none known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials (blank cells indicate that the particular outcome was not measured in some trials).
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial ((blank cells indicate that the particular outcome was not measured in some trials)
3
3
Trial flow diagram.
1.1
1.1. Analysis
Comparison 1 Vitamin D versus calcium, Outcome 1 Healing of rickets (normal alkaline phosphatase and bone radiograph).
1.2
1.2. Analysis
Comparison 1 Vitamin D versus calcium, Outcome 2 Healing of rickets (biochemical parameters). serum alkaline phosphatase.
1.3
1.3. Analysis
Comparison 1 Vitamin D versus calcium, Outcome 3 Healing of rickets (biochemical parameters): serum 25‐OHD.
1.4
1.4. Analysis
Comparison 1 Vitamin D versus calcium, Outcome 4 Healing of rickets (radiological).
1.5
1.5. Analysis
Comparison 1 Vitamin D versus calcium, Outcome 5 Morbidity (fractures).
2.1
2.1. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 1 Healing of rickets (normal alkaline phosphatase and bone radiograph).
2.2
2.2. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 2 Healing of rickets (biochemical parameters): serum alkaline phosphatase.
2.3
2.3. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 3 Healing of rickets (biochemical parameters): serum 25‐OHD.
2.4
2.4. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 4 Healing of rickets (radiological).
2.5
2.5. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 5 Morbidity (fractures).
2.6
2.6. Analysis
Comparison 2 Vitamin D plus calcium versus vitamin D, Outcome 6 Adverse events.
3.1
3.1. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 1 Healing of rickets (normal alkaline phosphatase and bone radiograph).
3.2
3.2. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 2 Healing of rickets (biochemical parameters): serum alkaline phosphatase.
3.3
3.3. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 3 Healing of rickets (biochemical parameters): serum 25‐OHD.
3.4
3.4. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 4 Healing of rickets (radiological).
3.5
3.5. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 5 Morbidity (fractures).
3.6
3.6. Analysis
Comparison 3 Vitamin D plus calcium versus calcium, Outcome 6 Adverse events.
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Update of

  • doi: 10.1002/14651858.CD012581

References

References to studies included in this review

Aggarwal 2013 {published and unpublished data}
    1. Aggarwal V, Seth A, Marwaha RK, Sharma B, Sonkar P, Singh S, et al. Management of nutritional rickets in Indian children: a randomized controlled trial. Journal of Tropical Pediatrics 2013;59(2):127‐33. - PubMed
    1. CTRI/2010/091/000448. Role of calcium and vitamin D in nutritional rickets and its management. ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=1634&EncHid=&amp... (first received 1 October 2010).
    1. Marwaha RK, Aggarwal V, Seth A, Sonkar P, Aneja S, Sharma B, et al. Role of calcium and vitamin D in the etiology and management of nutritional rickets. Osteoporosis International 2011;22:S730.
Balasubramanian 2003 {published data only}
    1. Balasubramanian K, Rajeswari J, Govil YC, Agarwal AK, Kumar A, Bhatia V. Varying role of vitamin D deficiency in the etiology of rickets in young children vs. adolescents in northern India. Journal of Tropical Pediatrics 2003;49(4):201‐6. - PubMed
Thacher 1999 {published and unpublished data}
    1. Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, et al. A comparison of calcium, vitamin D or both for nutritional rickets in Nigerian children. New England Journal of Medicine 1999;341(8):563‐8. - PubMed
Thacher 2014 {published and unpublished data}
    1. NCT00949832. Vitamin D and genetics in nutritional rickets. clinicaltrials.gov/ct2/show/NCT00949832 (first received 30 July 2009).
    1. Thacher TD, Fischer PR, Pettifor JM. Vitamin D treatment in calcium‐deficiency rickets: a randomised controlled trial. Archives of Disease in Childhood 2014;99:807‐11. - PMC - PubMed

References to studies excluded from this review

Arya 2000 {published data only}
    1. Arya V. Calcium and the treatment of nutritional rickets. National Medical Journal of India 2000;13(1):23. - PubMed
Atabek 2013 {published data only}
    1. Atabek ME. How should we manage vitamin D‐deficient adolescents?. Journal of Pediatric Endocrinology and Metabolism 2013;26(9‐10):1009‐10. - PubMed
Barr 1969 {published data only}
    1. Barr DG, Forfar JO. Oral calcium‐loading test in rickets and in neonatal tetany: effect of vitamin D. British Medical Journal 1969;3:150‐2. - PMC - PubMed
Curtis 1983 {published data only}
    1. Curtis JA, Kooh SW, Fraser DO, Greenberg M. Nutritional rickets in vegetarian children. Canadian Medical Association Journal 1983;128(2):150. - PMC - PubMed
Davis 1978 {published data only}
    1. Davies DP, Hughes CA, Moore JR. Rickets in preterm infants. Archives of Disease in Childhood 1978;53(1):88. - PMC - PubMed
Kutluk 2002 {published and unpublished data}
    1. Kutluk G, Çetinkaya F, Basak M. Comparisons of oral calcium, high dose vitamin D and a combination of these in the treatment of nutritional rickets in children. Journal of Tropical Pediatrics 2002;48(6):351‐3. - PubMed
NCT01512537 {published data only}
    1. NCT01512537. Alternative treatments of vitamin D deficiency. clinicaltrials.gov/ct2/show/NCT01512537 (first received 19 January 2012).
Rooze 2016 {published data only}
    1. Rooze S, Mathieu F, Claus W, Yangzom T, Yangzom D, Goyens P, et al. Effect of calcium and vitamin D on growth, rickets and Kashin–Beck disease in 0‐ to 5‐year‐old children in a rural area of central Tibet. Tropical Medicine & International Health 2016;21(6):768‐75. - PubMed
Zauche 2017 {published data only}
    1. Zauche LH. Rickets: not just a disease caused by vitamin D deficiency. Journal of Pediatric Health Care 2017;31(2):235‐40. - PubMed

References to studies awaiting assessment

El'chaninov 1969 {published data only}
    1. El'chaninov GM. The effect of videin D3 therapy of children with rickets. Voprosy Okhrany Materinstva i Detstva 1969;14(2):91. - PubMed

Additional references

Agarwal 2009
    1. Agarwal A, Gulati D, Rath S, Walia M. Rickets: a cause of delayed walking in toddlers. Indian Journal of Pediatrics 2009;76(3):269‐72. - PubMed
Allgrove 2004
    1. Allgrove J. Is nutritional rickets returning?. Archives of Disease in Childhood 2004;89(1):699‐701. - PMC - PubMed
Altman 2003
    1. Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ 2003;326(7382):219. [PUBMED: 12543843] - PMC - PubMed
Balasubramanian 2013
    1. Balasubramanian S, Dhanalakshmi K, Amperayani S. Vitamin D deficiency in childhood – a review of current guidelines on diagnosis and management. Indian Pediatrics 2013;50(7):669‐75. - PubMed
Bell 2013
    1. Bell ML, McKenzie JE. Designing psycho‐oncology randomised trials and cluster randomised trials: variance components and intra‐cluster correlation of commonly used psychosocial measures. Psycho‐oncology 2013;22(8):1738‐47. - PubMed
Borenstein 2017a
    1. Borenstein M, Higgins JP, Hedges LV, Rothstein HR. Basics of meta‐analysis: I² is not an absolute measure of heterogeneity. Research Synthesis Methods 2017;8(1):5‐18. - PubMed
Borenstein 2017b
    1. Borenstein M. Prediction intervals. www.meta‐analysis.com/prediction (accessed 3 July 2017).
Boutron 2014
    1. Boutron I, Altman DG, Hopewell S, Vera‐Badillo F, Tannock I, Ravaud P. Impact of spin in the abstracts of articles reporting results of randomized controlled trials in the field of cancer: the SPIIN randomized controlled trial. Journal of Clinical Oncology 2014;32(36):4120‐6. - PubMed
Buch 2011
    1. Buch MH, Aletaha D, Emery P, Smolen JS. Reporting of long‐term extension studies: lack of consistency calls for consensus. Annals of the Rheumatic Diseases 2011;70(6):886‐90. - PubMed
Callaghan 2006
    1. Callaghan AL, Moy RJ, Booth IW, Debelle G, Shaw NJ. Incidence of symptomatic vitamin D deficiency. Archives of Disease in Childhood 2006;91(7):606‐7. - PMC - PubMed
Cesur 2003
    1. Cesur Y, Caksen H, Gündem A, Kirimi E, Odabaş D. Comparison of low and high dose of vitamin D treatment in nutritional vitamin D deficiency rickets. Journal of Pediatric Endocrinology and Metabolism 2003;16(6):1105‐9. - PubMed
Cochrane 2018
    1. Cochrane. CENTRAL creation details. www.cochranelibrary.com/central/central‐creation (accessed 21 August 2018).
CONSORT
    1. The CONSORT statement. www.consort‐statement.org (accessed 19 May 2016).
Corbett 2014
    1. Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Research Synthesis Methods 2014;5(1):79‐85. - PubMed
Deeks 2019
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 10: Analysing data and undertaking meta‐analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
GRADEpro GDT 2015 [Computer program]
    1. McMaster University, 2015 (developed by Evidence Prime, Inc.). GRADEpro GDT. Version accessed 28 February 2017. Hamilton (ON): McMaster University, 2015 (developed by Evidence Prime, Inc.), 2015.
Greenbaum 2011
    1. Greenbaum LA. Rickets and hypervitaminosis D. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF editor(s). Nelson Textbook of Pediatrics. 19th Edition. Philadelphia (PA): Elsevier Saunders, 2011.
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2009
    1. Higgins JP, Thompson SG, Spiegelhalter DJ. A re‐evaluation of random‐effects meta‐analysis. Journal of the Royal Statistical Society. Series A, (Statistics in Society) 2009;172(1):137‐59. - PMC - PubMed
Higgins 2019a
    1. Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Higgins 2019b
    1. Higgins JP, Li T, Deeks JJ. Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Hochberg 2003
    1. Hochberg Z. Endocrine development. Vitamin D and Rickets. Vol. 6, Basel: Karger, 2003:220‐32.
Hozo 2005
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5:13. [DOI: 10.1186/1471-2288-5-13] - DOI - PMC - PubMed
Hróbjartsson 2013
    1. Hróbjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Hilden J, Boutron I, et al. Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors. Canadian Medical Association Journal 2013;185(4):E201‐11. - PMC - PubMed
Jessop 1950
    1. Jessop WJ. Results of rickets surveys in Dublin. British Journal of Nutrition 1950;4(2‐3):289‐92. - PubMed
Jones 2015
    1. Jones CW, Keil LG, Holland WC, Caughey MC, Platts‐Mills TF. Comparison of registered and published outcomes in randomized controlled trials: a systematic review. BMC Medicine 2015;13:282. [DOI: 10.1186/s12916-015-0520-3] - DOI - PMC - PubMed
Kirkham 2010
    1. Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365. [DOI: 10.1136/bmj.c365] - DOI - PubMed
Leclercq 2013
    1. Leclercq E, Leeflang MM, Dalen EC, Kremer LC. Validation of search filters for identifying pediatric studies in PubMed. Journal of Pediatrics 2013;162(3):629‐34. [PUBMED: 23084708] - PubMed
Lerch 2007
    1. Lerch C, Meissner T. Interventions for the prevention of nutritional rickets in term born children. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD006164.pub2] - DOI - PMC - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic and meta‐analyses of studies that evaluate interventions: explanation and elaboration. PLoS Medicine 2009;6(7):1‐28. [DOI: 10.1371/journal.pmed.1000100] - DOI - PMC - PubMed
Mathieu 2009
    1. Mathieu S, Boutron I, Moher D, Altman DG, Ravaud P. Comparison of registered and published primary outcomes in randomized controlled trials. JAMA 2009;302(9):977‐84. - PubMed
Meader 2014
    1. Meader N, King K, Llewellyn A, Norman G, Brown J, Rodgers M, et al. A checklist designed to aid consistency and reproducibility of GRADE assessments: development and pilot validation. Systematic Reviews 2014;3:82. [DOI: 10.1186/2046-4053-3-82] - DOI - PMC - PubMed
Megan 2012
    1. Megan B, Pickering RM, Weatherall M. Design, objectives, execution and reporting of published open‐label extension studies. Journal of Evaluation in Clinical Practice 2012;18(2):209‐15. - PubMed
Misra 2008
    1. Misra M, Pacaud D, Petryk A, Collett‐Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Paediatrics 2008;122(2):398‐417. - PubMed
Munns 2016
    1. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. Hormone Research in Paediatrics 2016;85(2):83‐106. - PubMed
Nield 2006
    1. Nield LS, Mahajan P, Joshi A, Kamat D. Rickets: not a disease of the past. American Family Physician 2006;74(4):619‐26. - PubMed
Ozkan 2010
    1. Ozkan B. Nutritional rickets. Journal of Clinical Research in Pediatric Endocrinology 2010;2(4):137‐43. - PMC - PubMed
Pal 2001
    1. Pal BR, Shaw NJ. Rickets resurgence in the United Kingdom: improving antenatal management in Asians. Journal of Pediatrics 2001;139(2):337‐8. - PubMed
Pettifor 2004
    1. Pettifor JM. Nutritional rickets: deficiency of vitamin D, calcium, or both?. American Journal of Clinical Nutrition 2004;80(6 Suppl):1725S‐9S. - PubMed
Pettifor 2005
    1. Pettifor JM. Rickets and vitamin D deficiency in children and adolescents. Endocrinology and Metabolism Clinics of North America 2005;34(3):537‐53. - PubMed
Pettifor 2012
    1. Pettifor JM. Nutritional rickets. In: Glorieux FH, Pettifor JM, Juppner H editor(s). Pediatric Bone. 2nd Edition. London: Elsevier, 2012:625‐54.
Pettifor 2014a
    1. Pettifor JM. How should we manage vitamin D deficiency rickets?. Indian Pediatrics 2014;51(4):259‐60. - PubMed
Pettifor 2014b
    1. Pettifor JM. International perspectives of rickets. 2014 Meet‐The‐Professor: Endocrine Case Management. Washington (DC): Endocrine Society, 2014:45‐9.
Pfitzner 1988
    1. Pfitzner MA, Thacher TF, Pettifor JM, Zoakah AI, Lawson JO, Isichei CO. Absence of vitamin D deficiency in young Nigerian children. Journal of Pediatrics 1998;133(6):740‐4. - PubMed
Prentice 2008
    1. Prentice A. Vitamin D deficiency: a global perspective. Nutrition Reviews 2008;66(Suppl 2):S153‐64. - PubMed
Reddy 2008
    1. Reddy V, Lamb WH. Specific vitamin deficiencies. In: Stanfield P, Brueton M, Chan M, Parkin M, Waterson T editor(s). Diseases of Children in the Subtropics and Tropics: a Global Text. 4th Edition. Zurich (Switzerland): Jacobs Foundation, 2008:376‐8.
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Riley 2011
    1. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta‐analyses. BMJ 2011;342:d549. - PubMed
Ross 2011
    1. Ross AC, Taylor CL, Yaktine AL, Valle HB. Committee to review dietary reference intakes for vitamin D and calcium. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academy Press, 2011. - PubMed
Scherer 2018
    1. Scherer RW, Meerpohl JJ, Pfeifer N, Schmucker C, Schwarzer G, Elm E. Full publication of results initially presented in abstracts. Cochrane Database of Systematic Reviews 2018, Issue 11. [DOI: 10.1002/14651858.MR000005.pub4] - DOI - PMC - PubMed
Schwalfenberg 2007
    1. Schwalfenberg G. Not enough vitamin D: health consequences for Canadians. Canadian Family Physician 2007;53(5):841‐54. - PMC - PubMed
Schünemann 2019
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing 'Summary of findings' tables and grading the confidence in or quality of the evidence. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Shaw 2004
    1. Shaw NJ, Kershaw M. Vitamin D deficiency in children. In: David TJ editor(s). Recent Advances in Paediatrics. London: Royal Society of Medicine Press, 2004:85‐100.
Sterne 2011
    1. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta‐analyses of randomised controlled trials. BMJ 2011;343:d4002. - PubMed
Thacher 2000
    1. Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Manaster BJ, Reading JC. Radiographic scoring method for the assessment of the severity of nutritional rickets. Journal of Tropical Pediatrics 2000;46(3):132‐9. - PubMed
Thacher 2003
    1. Thacher TD. Calcium‐deficiency rickets. Endocrine Development 2003;6:105‐25. - PubMed
Thacher 2006
    1. Thacher TD, Fischer PR, Strand MA, Pettifor JM. Nutritional rickets around the world: causes and future directions. Annals of Tropical Paediatrics 2006;26(1):1‐16. - PubMed
UNICEF 2015
    1. United Nations Children's Fund. Preventing bone disorders through better nutrition in Bangladesh. www.unicef.org/infobycountry/bangladesh_51457.html (accessed 30 March 2015).
Weisberg 2004
    1. Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. American Journal of Clinical Nutrition 2004;80(6 Suppl):1697S‐705. - PubMed
Welch 2000
    1. Welch TR, Bergstrom WH, Tsang RC. Vitamin D‐deficient rickets: the re‐emergence of a once‐conquered disease. Journal of Paediatrics 2000;137(2):143‐5. - PubMed
Wendling 2007
    1. Wendling P. Preventable nutritional rickets stages reemergence. Rheumatology News 2007;6(10):32.
Wong 2006
    1. Wong SS, Wilczynski NL, Haynes RB. Comparison of top‐performing search strategies for detecting clinically sound treatment studies and systematic reviews in MEDLINE and EMBASE. Journal of the Medical Library Association 2006;94(4):451‐5. - PMC - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ 2008;336(7644):601‐5. - PMC - PubMed

References to other published versions of this review

Chibuzor 2017
    1. Chibuzor MT, Graham‐Kalio D, Meremikwu MM, Adukwu JO. Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children. Cochrane Database of Systematic Reviews 2017, Issue 3. [DOI: 10.1002/14651858.CD012581] - DOI - PMC - PubMed

Publication types