Vitamin D is important for our health, and a deficiency in this important nutrient could lead to health problems occurring which affect the skeletal structure – these are basically the same condition under two different guises, known as rickets and osteomalacia. Rickets occurs in children, whilst osteomalacia is the term used for the condition when it is diagnosed in adults. Vitamin D can be sourced from your diet or from exposure to natural sunlight. Where your diet is concerned fatty fish, such as tuna, salmon or sardines, are great sources of vitamin D – you can also source it from margarine and fortified bread or cereals. Infant milk formula is also fortified with vitamin D, though human milk is a poor source of this nutrient. Most people however get most of their vitamin D intake from sunlight – studies suggest that the average person has enough vitamin D stored in their body to last two or three years. People who don’t get much exposure to the sun are at risk of becoming deficient in vitamin D, such as people in nursing homes or elderly people who are housebound. Immigrants from Asia and Africa are at risk, as are people who have an illness or lifestyle which makes outdoor activities difficult. Because of our increasingly sedentary lifestyles, vitamin D deficiency isn’t uncommon in today’s society. Some people with intestinal problems, such as coeliac disease or cystic fibrosis, may also become short on supply of this vitamin, as do people with liver disease. It’s also important to remember that an infant’s vitamin D status is dependent on that of its mother, so if the mother is deficient, the child may be born with rickets or early fractures later in their life.
Osteomalacia is characterised by bone pains and muscle weakness, as well as fractures occurring. These fractures may take place with hardly any or no trauma at all – these days, patients are commonly identified by a low bone density. In those with rickets, patients may suffer from aches and pains, as well as the visible enlargement of bones at joints, such as in the wrists. Some children with rickets also have convulsions. These conditions can be tested for with a simple blood test which tests for calcium, phosphate and alkaline phosphatase. In order to confirm the diagnosis though, you will require a more specific blood test – this includes the measurement of the levels of 25-hydroxyvitamin D, which is the main form of vitamin D in the blood, as well as parathyroid hormones. If necessary, patients may also need a bone density scanning. In children, x-rays of the wrists and knees are very helpful, but normal appearances don’t mean that rickets is excluded from the diagnoses.
There are various ways to treat vitamin D deficiency, but the most common is with regular daily supplements with or without calcium. An alternative to this is a single large oral dose or injection of the vitamin, which is stored by the body and can last for up to a year before another is needed. This option is advised for those with vitamin D deficiency caused by intestinal problems. Infants who are born prematurely often have bone problems which can lead to spontaneous fractures in their first few months of life. While this is referred to as rickets, there is no proof in this situation that vitamin D is the cause. There are uncommon forms of rickets caused by inborn defects due to the way that vitamin D is handled and absorbed by the body.
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