The Utility of Alkaline Phosphatase Measurement as a Screening Test for Rickets in Breast-fed Infants and Toddlers: A Study From the Puget Sound Pediatric Research Network
Restricted accessOtherFirst published online December, 2010
The Utility of Alkaline Phosphatase Measurement as a Screening Test for Rickets in Breast-fed Infants and Toddlers: A Study From the Puget Sound Pediatric Research Network
To determine if alkaline phosphatase (AP) levels are a useful screening test for rickets, the authors measured serum AP levels in children 6 to 15 months old who were predominantly breast-fed for >" xbd="1702" xhg="1679" ybd="1238" yhg="1210"/>6 months without vitamin D supplementation. Radiographs were obtained on children with elevated AP levels to determine the presence of rickets. AP levels were obtained on 246 children; levels were elevated in 33 (13.4%). Rickets was present in 4 of 18 children with elevated levels on whom radiographs were obtained. The sensitivity and specificity of AP levels as a test for rickets was maximal at a cutoff value of 552 U/L. Using this cutoff value, the specificity of AP levels as a test for rickets was 97.4%, and the positive predictive value (PPV) was 40.0%. These results suggest that AP levels may be a useful screening test for rickets in children who are breast-fed for prolonged periods without vitamin D supplementation.
Wagner CL, Greer FRPrevention of rickets and vitamin D deficiency in infants, children, and adolescents . Pediatrics. 2008;122:1142-1152.
2.
Gartner LM, Greer FRPrevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. 2003;111:908-910.
3.
Perrine CG, Sharma AJ, Jefferds ME, Serdula MK, Scanlon KSAdherence to vitamin D recommendations among US infants. Pediatrics. 2010;125:627-632.
4.
Taylor JA, Geyer LJ, Feldman KWUse of supplemental vitamin D among infants breastfed for prolonged periods . Pediatrics. 2010;125:105-111.
5.
Davenport ML , Uckun A., Calikoglu ASPediatrician patterns of prescribing vitamin supplementation for infants: do they contribute to rickets? Pediatrics. 2004;113: 179-180.
6.
Gordon CM, Feldman HA, Sinclair L., et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 2008;162:505-512.
7.
Weisberg P., Scanlon KS, Li R., Cogswell MENutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr. 2004 ;80:1697S-1705S.
8.
Posen S., Doherty E.The measurement of serum alkaline phosphatase in clinical medicine. Adv Clin Chem. 1981; 22:163-245.
9.
DeVito GA Jr.Transient elevation of alkaline phosphatase possibly related to trimethoprim-sulfamethoxazole therapy. J Pediatr. 1982;100:998-999.
10.
Liakakos D. , Papadopoulos Z., Vlachos P., Boviatsi E., Varonos DDSerum alkaline phosphatase and urinary hydroxyproline values in children receiving phenobarbital with and without vitamin D. J Pediatr. 1975;87:291-296.
11.
Crofton PMWhat is the cause of benign transient hyperphosphatasemia? A study of 35 cases . Clin Chem. 1988;34:335-340.
12.
Abbassi V., Colon AR, Schwartz RHBenign elevation of serum alkaline phosphatase, transient and persistent variety . Clin Pediatr (Phila). 1984;23:336-337.
13.
Tolaymat N. , de Melo MCBenign transient hyperphosphatasemia of infancy and childhood. South Med J. 2000;93:1162-1164.
14.
Huh SY, Feldman HA, Cox JE, Gordon CMPrevalence of transient hyperphosphatasemia among healthy infants and toddlers . Pediatrics. 2009;124:703-709.
15.
Cow milk-based infant formulas: label claim nutrient contents (per L at 20 kcal/oz). In: Kleinman RE, ed. Pediatric Nutrition Handbook. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:1250-1258.
16.
Kleinman JM , Robins DL, Ventola PE, et al. The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord. 2008 ;38:827-839.
17.
Thompson DC , McPhillips H., Davis RL, Lieu TL, Homer CJ, Helfand M.Universal newborn hearing screening: summary of evidence. JAMA. 2001;286:2000-2010.
18.
Centers for Medicaid and Medicare Services.Clinical laboratory fee schedule. http://www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp#TopOfPage. Accessed September 24, 2008.
19.
Joiner TA, Foster C., Shope T.The many faces of vitamin D deficiency rickets. Pediatr Rev . 2000;21:296-302.
20.
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. Pediatrics. 2008;122:398-417.
21.
Slovis TL, Chapman S.Evaluating the data concerning vitamin D insufficiency/deficiency and child abuse. Pediatr Radiol. 2008;38:1221-1224.
22.
Glaser K.Double contour, cupping and spurring in roentgenograms of long bones in infants . Am J Roentgenol Radium Ther Nucl Med. 1949 ;61:482-492.
23.
Goel KM, Sweet EM, Logan RW, Warren JM, Arneil GC, Shanks RAFlorid and subclinical rickets among immigrant children in Glasgow. Lancet. 1976;1:1141-1145.
24.
Erfan AA, Nafie OA, Neyaz AA, Hassanein MAVitamin D deficiency rickets in maternity and Children’s Hospital, Makkah, Saudi Arabia. Ann Saudi Med. 1997; 17:371-373.
25.
Ladizesky M. , Lu Z., Oliveri B., et al. Solar ultraviolet B radiation and photoproduction of vitamin D3 in central and southern areas of Argentina. J Bone Miner Res. 1995;10:545-549.
26.
Aegerter EE, Kirkpatrick JAMetabolic diseases of bone. In: Orthopedic Diseases, Physiology, Pathology, Radiology. 4th ed. Philadelphia, PA: W B Saunders; 1975: 331-349.
