Case of the Month – March 2018
By Dr Mark Ready
21 month old girl from Africa. Bowed Legs. Biochemistry confirms low Vitamin D.
METAPHYSEAL CHANGES: Sclerosis, splaying and beaking.
EPIPYSEAL CHANGES: Loss of dense outline.
Other X-ray changes one would expect to see, which are not present in this case are:
Periosteal reaction along diaphysis; Generalised demineralision; Coxa Vara; Cupping and widening rib ends – “rachitic rosary”; Scoliosis and biconcave vertebrae
Vitamin D deficiency – dietary or decreased exposure to sunlight.
Vitamin D required for calcium absorption from gut and renal tubules
Regulates apoptosis of chondrocytes, cartilage matrix mineralisation and metaphyseal angiogenesis.
Leukemia, Metastatic neuroblastoma, non-accidental injury, bone dysplasia.