Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 2226-2230 (doi:10.1542/peds.2006-1170)
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EXPERIENCE & REASON

Hypocalcemic Seizures and Secondary Bilateral Femoral Fractures in an Adolescent With Primary Vitamin D Deficiency

David Schnadower, MD, MPHa, Chhavi Agarwal, MDb, Sharon E. Oberfield, MDb, Ilene Fennoy, MD, MPHb and Martin Pusic, MD, MAa

a Divisions of Pediatric Emergency Medicine
b Pediatric Endocrinology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York

ABSTRACT

Nutritional rickets and osteomalacia are reemerging in Western societies, particularly in young children and in adolescents of African or Asian descent. Hypocalcemic seizures resulting from vitamin D deficiency are rare in adolescents, whereas fractures caused by seizures without evidence of direct trauma have not yet been reported in this population. We present an unusual case of secondary bilateral femoral fractures caused by hypocalcemic seizures in a 17-year-old boy with primary vitamin D deficiency. We examine the epidemiology and the clinical presentation of rickets and osteomalacia in the adolescent population, the risk of secondary injuries in patients with seizures, and the evaluation and management of hypocalcemic seizures and primary vitamin D deficiency.

Key Words: adolescents • rickets • hypocalcemia • seizures • fractures

Abbreviations: PTH, parathyroid hormone

Accepted Jun 12, 2006.