{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T03:19:25Z","timestamp":1764645565427,"version":"3.37.3"},"reference-count":30,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100005627","name":"Thrasher Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Nutritional rickets results from the interaction of low vitamin D status and limited calcium intake. Serum alkaline phosphatase (AP) activity is a biomarker of impaired mineralization in rickets.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the performance of serum AP activity in identifying nutritional rickets in calcium-deprived Nigerian children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We reanalyzed data from a case-control study of children with active rickets and matched control subjects without rickets, using a multivariate logistic regression to assess the odds of rickets associated with AP activity, adjusting for age, sex, and weight-for-age z-score.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 122 children with rickets and 119 controls were included. Rachitic children had a mean (\u00b1SD) age of 54\u2005\u00b1\u200529 months, and 55 (45.1%) were male. Cases and controls had low dietary calcium intakes (216\u2005\u00b1\u200587 and 214\u2005\u00b1\u200596 mg\/day, respectively). Serum AP activity levels in cases and controls were 812\u2005\u00b1\u2005415 and 245\u2005\u00b1\u200578 U\/L, respectively (P\u2005&amp;lt;\u20050.001). AP was negatively associated with 25-hydroxyvitamin D values (r\u2005=\u2005\u22120.34; P\u2005&amp;lt;\u20050.001). In the adjusted model, the odds ratio (95% CI) receiver operating characteristic curve was 0.978. AP\u2005&amp;gt;\u2005350 U\/L identified nutritional rickets in Nigerian children with sensitivity 0.93, specificity 0.92, positive likelihood ratio 11.3, and negative likelihood ratio 0.07.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>An AP\u2005&amp;gt;\u2005350 U\/L effectively discriminated between Nigerian children with and without nutritional rickets. AP is a low-cost biochemical test that could be used to screen for nutritional rickets, but cutoff values require validation in other populations, and laboratory values need to be standardized for widespread population studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab328","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T03:47:02Z","timestamp":1620877622000},"page":"e3559-e3564","source":"Crossref","is-referenced-by-count":6,"title":["The Validity of Serum Alkaline Phosphatase to Identify Nutritional Rickets in Nigerian Children on a Calcium-Deprived Diet"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-8173","authenticated-orcid":false,"given":"Tom D","family":"Thacher","sequence":"first","affiliation":[{"name":"Family Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1324-3282","authenticated-orcid":false,"given":"Christopher T","family":"Sempos","sequence":"additional","affiliation":[{"name":"Vitamin D Standardization Program, Havre de Grace, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6563-7107","authenticated-orcid":false,"given":"Ramon A","family":"Durazo-Arvizu","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0876-8789","authenticated-orcid":false,"given":"Philip R","family":"Fischer","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5898-5808","authenticated-orcid":false,"given":"Craig F","family":"Munns","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes, The Children\u2019s Hospital at Westmead, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1155-0334","authenticated-orcid":false,"given":"John M","family":"Pettifor","sequence":"additional","affiliation":[{"name":"MRC\/Wits Developmental Pathways for Health Research Unit, Paediatrics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2021120108562106200_CIT0001","doi-asserted-by":"crossref","DOI":"10.1093\/ajcn\/nqab048","article-title":"Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet-a multivariable reanalysis","author":"Sempos","year":"2021","journal-title":"Am J Clin Nutr."},{"issue":"2","key":"2021120108562106200_CIT0002","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/20469047.2016.1248170","article-title":"Nutritional rickets around the world: an update","volume":"37","author":"Creo","year":"2017","journal-title":"Paediatr Int Child Health."},{"key":"2021120108562106200_CIT0003","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40985-016-0018-3","article-title":"Nutritional rickets in immigrant and refugee children","volume":"37","author":"Thacher","year":"2016","journal-title":"Public Health Rev."},{"issue":"1","key":"2021120108562106200_CIT0004","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/nyas.13968","article-title":"Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income 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