Rickets are back
Vitamin D is important for bone and muscle health, hers deficiency can cause serious complications such as osteomalacia, rickets, hypo-calcaemic seizures and cardiac problems.
Hypo-calcaemic complications are considered rare in high income countries nevertheless dark skins pigmentation, lack of sunshine and extensive clothing can dangerously reduce cutaneous Vitamin D production and increase the risk for people from South Asia, Africa and Middle East. The global migration from these regions changes the demographics of several European countries and creates new heath challenges. Rickets is a rare disease but is highly prevalent among Black, Asian and Minority Ethnic (BAME) groups. Babies and young children are particularly at risk especially when breast-fed as mother milk is not particularly rich in vitamin D (and mothers might be Vitamin D deficient as well). For these reasons most European countries have a national policy in place for vitamin D supplementation in infancy and childhood.
A regional EU survey in 2017 shows significant variations in program duration, follow up system and adherence to the therapy, UK is by far the one with the lowest adherence rate.
In the UK, supplements are not commenced until 6 months of age, which contributes to the rising incidence of rickets. Several studies describe severe hypo-calcaemic seizures, episodes of deaths from hypo-calcaemic cardiomyopathy, and undiagnosed rickets found post-mortem after unexplained sudden infant deaths. A lot of these children were from dark-skinned ethnic origin, and fully breastfed.
The outcomes analysis performed on the supplementation programs in place in Europe all concur in recommending:
- All infants, pregnant women and risk groups should receive preventative vitamin D supplements;
- Clear implementation strategies and responsibilities;
- Monitoring adherence at child health surveillance visits;
- Financial support to lowest income families.
In order to get optimal adherence and avoid serious risks and avoidable healthcare costs.
The morbidity and mortality from Vitamin D deficiency is fully preventable. The appropriate supplementation is a low-cost therapy. The return of the ‘English disease’ (rickets name during the industrial revolution) can be avoided with a renewed effort of public disease policy.