Rickets in the 21st century: A review of the consequences of low vitamin D and its management

Normal bone growth is reliant on adequate serum levels of vitamin D. Hypovitaminosis D (insufficiency or deficiency of vitamin D), now known to be prevalent in UK (Davies et al., 2011) is linked to the child presenting with musculoskeletal symptoms and deformity, including rickets (Judd, 2011). Whether caring for children in hospital, the community or in schools, nurses have an important role to play in identifying children at risk of having hypovitaminosis D and in educating parents in healthy dietary intake and supplementation where necessary (Box 3), to avert health problems associated with low vitamin D levels.This paper discusses contributory factors of hypovitaminosis D, reflects on the consequential orthopaedic health issues (Clarke and Page, 2012), (in particular nutritional rickets) and discusses the role of the nurse in prevention and management of hypovitaminosis D. Audit data from the author’s institute demonstrates the prevalence of low vitamin D in the paediatric orthopaedic population in Southampton, the generalised musculoskeletal symptoms complaints and the link to instigated sun protection.