ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2016) 44 S5.3 | DOI: 10.1530/endoabs.44.S5.3

Prevention and management of nutritional rickets; a 21st century approach

Wolfgang Hogler1,2

1Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham, UK; 2Institute of Metabolism and systems Research, University of Birmingham, Birmingham, UK.

Calcium and phosphorus represent the main building material for bone stiffness. The supplier of these bone minerals is the hormone calcitriol, which originates from vitamin D, itself made by sunshine in human skin. Requirement for bone mineral supply is highest during phases of rapid growth, such as in the foetus, infant and pubertal child, making them particularly vulnerable.

Deprivation of calcium, whether through low dietary calcium intake and/or low vitamin D, leads to serious health consequences throughout life, such as hypocalcaemic seizures, dilated cardiomyopathy, skeletal myopathy, congenital and infantile rickets, and osteomalacia. These 5 conditions, often summarised as ‘symptomatic vitamin D deficiency’, are fully reversible but also fully preventable.

However, in the 21st century, calcium deprivation has reached epidemic proportions, not only in the third world, but also in high-income countries - specifically amongst dark-skinned and other at-risk ethnic populations. The increasing prevalence of rickets and osteomalacia, and the deaths from hypocalcaemic cardiomyopathy, demand action from global health care providers. Clarification of medical and parental responsibilities is a prerequisite to deliver successful prevention programmes, and the UK lags behind most other European countries.

The quality of a nation’s public health can be derived from how it treats and invests in its children and other vulnerable risk groups. The foetus and infant have the human right to be protected against harm. Prevention programs, including vitamin D supplementation and food fortification, should have the same public health priority as vaccinations. The global consensus for the prevention of management of rickets has provided evidence-based guidance on how such programs can be delivered, and recommend vitamin D supplementation for pregnant women, infants, and risk groups.

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