{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:28:34Z","timestamp":1767598114950},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[1994,4,1]],"date-time":"1994-04-01T00:00:00Z","timestamp":765158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"The South African Medical Research Council"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1994,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Calcium deficiency in black (African) children can cause rickets and osteomalacia with severe limb deformities. It is not known whether black teenagers with genu valgum or varum but without radiologic rickets suffer from a related disorder. To examine this question we studied 26 such patients by iliac crest bone biopsy and serum and urine biochemistry: 12 patients (46%) had osteopenia with normal or low bone turnover, 5 (19%) mildly increased bone turnover, 4 (15%) histologic hyperparathyroidism, 2 (8%) preosteomalacia, and 3 (12%) osteomalacia (with features of hyperparathyroidism). Radiographs did not reflect the severity of the bone disease. Serum calcium levels correlated inversely with eroded mineralized surface (p &amp;lt; 0.001), osteoid surface (p &amp;lt; 0.01), osteoid thickness (p &amp;lt; 0.001), mineralization lag time (p &amp;lt; 0.001), and 1,25-(OH)2 vitamin D (p &amp;lt; 0.005), and 1,25-(OH)2 vitamin D correlated positively with osteoid surface (p &amp;lt; 0.05), osteoid thickness (p &amp;lt; 0.05), osteoid volume (p &amp;lt; 0.01), eroded surface (p &amp;lt; 0.05), and eroded mineralized surface (p &amp;lt; 0.0005). Tubular reabsorption of phosphate and 25-OH vitamin D levels were normal, and 1,25-(OH)2 vitamin D levels were normal to high. This suggests that calcium deficiency may have caused the increase in bone turnover and the mineralization defects. The most severe osteomalacia was found in males aged 16\u201319 years. We cannot explain the cause of the osteopenia. We conclude that all patients had bone disease.<\/jats:p>","DOI":"10.1002\/jbmr.5650090407","type":"journal-article","created":{"date-parts":[[2010,2,3]],"date-time":"2010-02-03T16:31:54Z","timestamp":1265214714000},"page":"479-486","source":"Crossref","is-referenced-by-count":24,"title":["Metabolic bone disease in black teenagers with genu valgum or varum without radiologic rickets: A bone histomorphometric study"],"prefix":"10.1093","volume":"9","author":[{"given":"Christine M.","family":"Dr. Schnitzler","sequence":"first","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Pettifor","sequence":"additional","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Patel","sequence":"additional","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia M.","family":"Mesquita","sequence":"additional","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gopal P.","family":"Moodley","sequence":"additional","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dianne","family":"Zachen","sequence":"additional","affiliation":[{"name":"MRC Mineral Metabolism Research Unit and Departments of Orthopaedic Surgery and Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1994,4,1]]},"reference":[{"key":"2024013113132067000_bib1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/0221-8747(81)90013-8","article-title":"Dietary calcium deficiency: A syndrome associated with bone deformities and elevated serum 1,25-dihydroxyvitamin D concentrations","volume":"2","author":"Pettifor","year":"1981","journal-title":"Metab Bone Dis"},{"key":"2024013113132067000_bib2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0169-6009(89)90084-6","article-title":"Endemic skeletal fluorosis in children: Hypocalcaemia and the presence of renal resistance to parathyroid hormone","volume":"7","author":"Pettifor","year":"1989","journal-title":"Bone Miner"},{"key":"2024013113132067000_bib3","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/S0140-6736(73)92006-0","article-title":"Genu valgum and osteoporosis in an area of endemic fluorosis","volume":"2","author":"Krishnamachari","year":"1973","journal-title":"Lancet"},{"key":"2024013113132067000_bib4","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1259\/0007-1285-39-466-761","article-title":"Fluorosis in young persons. 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