Effectiveness of STOSS Therapy Verses Alternate Strategy of Vitamin D in the treatment of Nutritional Rickets: A study in Dhaka Shishu Hospital, Dhaka,Bangladesh

Background: Nutritional rickets remains prevalent in many tropical countries like Bangladesh despite the fact thatsuch countries have ample sunlight. Some postulate that a deficiency of dietary calcium and vitamin D are often responsible for rickets in infancy. It causes considerable disability among childrenNutritional rickets resulting from vitamin D deficiency has become an increasing concern in both developed and developing countries. However, recommended treatment options are either small doses dailysupplementation of vitamin D for few months or single-day high-dose vitamin D, an approach referred to as stoss therapy. 27 But it was observed in clinical practice that a significant number of children getting Stoss therapy for nutritional rickets but few of them did not cure from nutritional rickets completely and developed rickets again. Considering the importance of the topics and limited study, this comparative study was designed to assess the effectiveness of Stoss therapy verses Alternate Strategy in nutritional rickets in Bangladeshi children. Material& Methods: This was an open label observational comparative study conducted in Dhaka Shishu (children) Hospital for 3-years period. Formal ethical clearance was taken prior commencement of the study. Total 100 children suffering from nutritional rickets were selected according to selection criteria. Written informed consent were taken from the parents of the child. The children were divided into two groups. One administered Stoss Therapy and other administered as Alternate Strategy. Stosstherapy (under proper guide lines of the researcher) was given 50 children under the Stoss therapy group: A, and another 50 children were under Alternate Strategy group:B, and they were given alternate oraldose (2000-5000 IU of vitamin D2/day for 12weeks. Before starting therapy clinical features and relevant investigations were recorded and it was compared with the value at 3 weeks, 3 months and 6 months follow up visit both the groups. Recoded data was analyzed by statistical software, SPSS 20 with 95% CI and acceptable 5%error. Results: Among the 100 rachitic children mean age was 29.30±2.00 SD months (age range: 12-60 months). Median age was 26 months with 56% male and 44% female respondents. Following Stoss therapy and Alternate Strategy significant clinical improvement was seen at 3 months and almost complete resolution of the most of the features over a period of 6 months in both the groups, Significant improvement of different biochemical parameters (serum calcium, phosphate, ALP, and vitamin 25-OH-D) were seen and restored to almost normal level during 6 months in Stoss therapy. In Stosstherapy at the six month the mean serum vitamin 25-OH-D was 30.22±2.53. On the other hand, in Alternate Strategy at six month the mean serum vitamin 25-OH-D was found 60.12±7.63 which was double of Stoss therapy. Comparatively, better result was found in Alternate Strategy which is statistically significant (p<0.001). Radiological improvement was measured by Thacher’s 10 pointscale and significant improvement starts at 3 weeks which become completely normal at 6 months post therapy (p<.001). Conclusion: The Alternate Strategy (that means the oral dose of (2000 5000) IU/day vitamin D2for 12weeks) is more superior, effective and safe in nutritional rickets children in Bangladesh than that of single dose/day in Stoss therapy.