Comparison of Limestone and Ground Fish for Treatment of Nutritional Rickets in Children in Nigeria

Objective To determine whether children with calcium-deficiency rickets respond better to treatment with calcium as limestone or as ground fish. Study design Nigerian children with active rickets (n = 96) were randomized to receive calcium as powdered lime-stone (920 mg of elemental calcium) or ground fish (952 mg of elemental calcium) daily for 24 weeks. Radiographic healing was defined as achieving a score of 1.5 or less on a 10-point scale. Results The median (range) age of enrolled children was 35 (6-151) months. Of the 88 children who completed the study, 29 (66%) in the ground fish group and 24 (55%) in the limestone group achieved the primary outcome of a radiographic score of 1.5 or less within 6months (P = .39). The mean radiographic score improved from 6.2 +/- 2.4 to 1.8 +/- 2.2 in the ground fish group and from 6.3 +/- 2.2 to 2.1 +/- 2.4 in the limestone group (P = .68 for group comparison). In an intention to treat analysis adjusted for baseline radiographic score, age, milk calcium intake, and serum 25-hydroxyvitamin D concentration, the response to treatment did not differ between the 2 groups (P = .39). Younger age was associated with more complete radiographic healing in the adjusted model (aOR 0.74 [95% CI 0.57-0.92]). After 24 weeks of treatment, serum alkaline phosphatase had decreased, calcium and 25-hydroxyvitamin D increased, and bone mineral density increased in both groups, without significant differences between treatment groups. Conclusion In children with calcium-deficiency rickets, treatment with calcium as either ground fish or limestone for 6 months healed rickets in the majority of children.