Remember Rickets? They are Back

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If the word “rickets” makes you think of third-world countries or days of old, think again. A new study from Newcastle University finds that the numbers of this disorder that causes bones to soften and break are increasing, with more than 20 cases reported every year in Newcastle alone.

Rickets is caused by a vitamin D deficiency, a problem that affects people of all ages and one that is associated with a wide spectrum of health problems, ranging from depression to cardiovascular disease, diabetes, osteoporosis, and certain cancers. When children are vitamin D deficient, rickets can result.

According to the American Academy of Family Physicians, children ages 6 to 24 months are at the highest risk of rickets because their bones are growing very rapidly during that time. Children can also be at risk if they have dark skin, do not get enough exposure to sunlight, do not consume enough foods that contain vitamin D, calcium, or phosphorus, or they breastfeed without a vitamin D supplement.

This new study, authored by Professor Simon Pearce and Dr. Tim Cheetham of Newcastle Biomedicine, a collaboration between Newcastle University and the Newcastle Hospitals NHS Foundation Trust, urges that vitamin D be added to food products in an effort to stop the increase in the number of children who are developing rickets.

While the study notes that vitamin D deficiency is a significant problem in the United Kingdom, with 50 percent of adults deficient and one in six suffering with a severe deficiency, this problem is by no means limited to the British. The Centers for Disease Control and Prevention report a markedly high prevalence of severe vitamin D deficiency among Americans of all ages. The National Health and Nutrition Examination Survey (NHANES) 2001-2004 report noted that 7.6 million children in the United States are vitamin D deficient.

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According to the Newcastle study, one reason for vitamin D deficiency in the UK is that the traditional diet lacks enough of the nutrient. It also pointed to the fact that children are spending more time indoors playing video and computer games rather than going outside. Dr. Cheetham, Senior Lecturer in Paediatric Endocrinology at Newcastle University, noted in the institution’s news release that he is “dismayed by the increasing numbers of children we are treating with this entirely preventable condition.”

Rickets is characterized by painful, deformed bow legs and can cause delayed growth, pain in the pelvis and spine, and muscle weakness. Some children also have problems with their teeth, including abnormal tooth structure and cavities.

To address vitamin D deficiency and the rising number of cases of rickets, the study’s authors propose a change in public health policy, including supplementing foods with vitamin D (which is currently not done in the UK but is in many other countries). Children and adults alike would also benefit by getting more exposure to sunlight.

According to the Vitamin D Council, people who regularly do not get enough sunlight exposure need to supplement with at least 5,000 IU of vitamin D daily. Exposure to summer sun for 20 to 30 minutes allows the skin to produce about 10,000 IU. To help get enough vitamin D, individuals can take supplements on a daily basis and then get a vitamin D blood test to check their levels. The Council recommends blood levels between 50 and 80 ng/mL year round.

Professor Simon Pearce noted that healthcare professionals have been slow to address the problem of vitamin D deficiency. One result of the lack of action appears to be a rising number of cases of rickets among children. In the United States, the Agency for Healthcare Research and Quality notes that there is no national reporting system for rickets, yet indications are that the condition is on the rise. A disease many have considered a thing of the past is back. We have the ability to make rickets a thing of the past again.

SOURCES:
Agency for Healthcare Research and Quality
American Academy of Family Physicians
Newcastle University news release, Jan. 21, 2010
NHANES 2001-2004
Plotnikoff GA. Weather or not: the importance of vitamin D status monitoring and supplementation. Minn Med 2009 Nov; 92(110: 43-46
Vitamin D Council

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