ESPE Abstracts (2018) 89 S3.4

Prevention and Management of Rickets

Wolfgang Högler


Kepler Universitaetsklinikum, Linz, Austria


Calcium and phosphorus represent the main building material for bone and growth plate mineralization and 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 during pregnancy, infancy and puberty. The body can be deprived of calcium either through low dietary calcium intake and/or low vitamin D. Such calcium deprivation can lead to serious health consequences throughout life, such as hypocalcaemic seizures, dilated cardiomyopathy, skeletal myopathy, ‘nutritional’ rickets and osteomalacia. These five conditions, often summarised as ‘symptomatic vitamin D deficiency’, are fully reversible but also fully preventable. Asymptomatic and undiagnosed morbidity from vitamin D or calcium deficiency is the subject of intensive research. 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 populations. The increasing prevalence of rickets and osteomalacia, and infant deaths from hypocalcaemic cardiomyopathy, demand action from global health care providers. The global consensus for the prevention of management of rickets has provided evidence-based guidance on how such programs can be delivered and recommends vitamin D supplementation for risk groups (min 600 IU/day), pregnant women (min 600 IU/day), and infants (min 400 IU/day). The success of prevention programs is intrinsically linked to policy implementation, including accountability of medical and parental responsibilities. Our work outlines substantial differences in supplementation policies and their efficacy in Europe and calls for better policy implementation strategies and also well-designed food fortification with vitamin D. The quality of a nation’s public health standards 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.

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