ESPE Abstracts (2014) 82 FCLB6

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Craig Munnsa, Nick Shawb, Mairead Kielyc, Bonny Speckerd, Thomas Thachere & Wolfgang Hoglerb


aThe Children’s Hospital at Westmead, Sydney, New South Wales, Australia; bBirmingham Children’s Hospital, Birmingham, UK; cUniversity College, Cork, Ireland; dSouth Dakota State University, Brookings, South Dakota, USA; eMayo Clinic, Rochester, New York, USA


Background: Vitamin D and/or calcium deficiency are very common in many areas worldwide, causing nutritional rickets, osteomalacia, hypocalcaemic seizures, cardiomyopathy, and muscle weakness. Nutritional rickets is defined as impaired mineralization at the growth plate. Untreated rickets leads to bone deformity, disability, obstructed labor, and reduced quality of life. The prevalence of nutritional rickets is increasing globally.

Objective and methods: 33 nominated experts in paediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics were allocated to working groups with assigned topics and specific questions. A systematic literature search was conducted to identify key articles relating to the definition, diagnosis, risk factors and strategies for prevention and management of nutritional rickets and osteomalacia. Each group evaluated the evidence using the GRADE system and met for a multi-day conference at the end of May 2014 to reach a global evidence-based consensus.

Results: The consensus group established definitions for rickets, vitamin D and calcium deficiency; intakes of vitamin D and calcium required for prevention and treatment of rickets and osteomalacia including women of childbearing age, pregnancy and lactation, and identification of risk groups who benefit from screening and supplementation. The group also developed a number of recommendations. Women of childbearing age, particularly during pregnancy, should meet their recommended intakes of calcium and vitamin D. All infants should be supplemented with 400 IU/day of vitamin D until 12 months of age, and calcium-rich foods should be introduced no later than 6 months. Food fortification with vitamin D is recommended to increase average population intakes to 400 IU/day, a level that would eradicate rickets and osteomalacia.

Conclusion: Nutritional rickets, a fully preventable disorder, is on the rise worldwide and should be regarded as a global epidemic. We advocate for eradication of rickets and osteomalacia through implementation of international vitamin D supplementation and food fortification programs.

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