Evaluating the Efficacy of STOSS Therapy in the Management of Nutritional Rickets in Pediatric Patients - A Study in Bangladesh

Abstract

Introduction: Nutritional rickets is a common childhood disease in Bangladesh, caused by a lack of vitamin D and calcium in the diet. STOSS therapy, a high-dose vitamin D treatment, has shown promise in managing this condition. This study aimed to examine the prevalence and clinical features of skeletal deformities in children with rickets in Bangladesh and evaluate the effectiveness of STOSS therapy in managing the condition. Methods: This 3-year observational study at Dhaka Shishu Hospital, Bangladesh, involved 80 children aged 1-5 years with nutritional rickets who were clinically and radiologically evaluated. Patients with chronic illnesses or prior treatment for rickets were excluded. Vitamin D deficiency was set at <30nmon/l for diagnosis. Result: In the study, 80 participants were divided into age groups: 41.25% were 12-23 months, 28.75% were 24-35 months, 20% were 36-47 months, 7.5% were 48-59 months, and 2.5% were ≥60 months old. Of the participants, 52.5% lived in urban areas and 47.5% lived in rural areas. The parents' education was 32.5% illiterate, 30% had primary education, 26.25% had secondary education, and 12.5% were graduates. The economic status of families was 62.5% lower, 30% middle, and 7.5% upper. The most common lower limb deformity was Bow Leg (52.50%), followed by Knock Knee (25.00%), and the most common upper limb deformity was Swelling Wrist (27.50%). Swollen wrist and/or ankle was the most common clinical feature (56.25%), followed by frontal bossing (53.75%). After 3 weeks, swollen wrist and/or ankle decreased to 32.50%, while frontal bossing was present in 40.00%, genu vulgum in 40.00%, genu verum in 27.50%, and pot belly in 13.75%. Serum calcium and phosphate levels increased significantly, while ALP levels decreased significantly. Serum Vitamin D levels did not increase significantly from a baseline mean of 11.18±0.39 ng/ml. Conclusion: STOSS therapy was not highly effective in reversing skeletal changes and correcting mineral and Vitamin D deficiencies, with no significant adverse effects reported. These findings suggest that STOSS therapy is not effective treatment for pediatric patients with nutritional rickets.