I recently wrote about a new paper by Cohen et al:
This paper deserves further comment.
It is a study of sudden death in children, mainly SIDS.
The study showed that 87% of the SIDS babies less than one year of age showed histopathological evidence of rickets. However, none of the cases of sudden death in children over the age of one showed rickets. Therefore, in this series of deceased infants and children, rickets presented as infantile rickets.
Radiological rickets was not picked up in any of the 13 histo-positive cases of rickets. Thus, radiology was woefully inadequate in diagnosing rickets, either due to the lack of sensitivity of x-rays or due to lack of appropriate recognition of x-ray signs of rickets by pediatric radiologists who are unfamiliar with the spectrum of rachitic radiographic changes.
While the prevalence of rickets increased with lower D levels, individually rickets was absent with 25(OH)D levels as low as 2.4 ng/ml and rickets was present with 25(OH)D levels as high as 52 ng/ml. This confirms what has been previously widely reported-that rickets is multifactorial and no 25(OH)D threshold levels can reliably predict the presence or absence of rickets. In all likelihood, this is due to calcium intakes, with high calcium intakes and low 25(OH)D levels in children without rickets, and very low calcium intakes and high 25(OH)D in children with rickets.