Orthopaedist Beware: Severe Nutritional Rickets and Autism Spectrum Disorder
Abstract
BACKGROUND: The prevalence of autism spectrum disorder (ASD) continues to rise in the United States, and many affected children have highly selective diets and sensory-driven food aversions that increase the risk of micronutrient deficiencies. In low-resource settings, food insecurity and limited access to autism evaluation and supportive services may further heighten this risk. At our urban tertiary pediatric center, we have diagnosed severe nutritional rickets in a number of children and adolescents with ASD and restrictive diets. This case series describes the clinical, metabolic, and orthopaedic manifestations of nutritional rickets in this population.
METHODS: We performed a retrospective chart review at a single urban tertiary children's hospital to identify pediatric and adolescent patients with ASD who presented with symptomatic nutritional rickets from 2019 to 2024. Patients were included if they had clinical findings concerning for rickets, laboratory evidence of vitamin D deficiency (with or without hypocalcemia), and radiographic findings consistent with rickets. We collected demographics, presenting symptoms, dietary patterns, key examination findings, laboratory values, imaging features, management, and outcomes, including follow-up calcium and vitamin D levels. Socioeconomic status was characterized using the Child Opportunity Index (COI) 2.0 by a residential ZIP code.
RESULTS: Eleven patients (age: 4-16 years) met the inclusion criteria. All patients resided…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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