These are the disorders that are caused by a less than adequate intake of vitamin D. They are really the same condition; rickets is the name used when it occurs in children while osteomalacia is used for adults.

There are two sources of vitamin D:

• Diet.
• Formation in the skin.

Dietary sources of vitamin D are rather few; the best ones are fatty fish such as salmon and sardines, and margarine which is supplemented with vitamin D. Milk contains added vitamin D in the USA but not in the UK. Most people in Scotland actually get most of their vitamin D from exposure of the skin to sunlight containing ultra-violet light. People with an ‘average’ lifestyle have enough stored vitamin D in their bodies to last for two or three years.

In Britain the people most at risk of vitamin D deficiency are those who, for one reason or another, get little exposure to sunlight. Immigrants from Asia, particularly women and children, are at risk, as are elderly people living at home but not getting out and elderly people in some residential and nursing homes.

In addition some people with intestinal problems such as Crohn’s disease and coeliac disease may become short of vitamin D.

In osteomalacia there may be widespread bone pains and sometimes muscle weakness. Fractures can occur. In rickets aches and pains may occur and there may be visible enlargement of some bone ends such as at the wrists.

In adults blood tests are most helpful in identifying osteomalacia but some patients also have a reduced bone density on bone density scanning. In children x-rays, particularly of the wrists and knees, are useful but blood tests may also help.

How do we treat osteomalacia and rickets?

One method involves regular daily doses of vitamin D and calcium. A simpler approach for many people is to give a single injection of 7.5 milligrams or 15 milligrams calciferol. This is stored in the tissues and lasts between six months and a year before another injection may be needed. Extra calcium may also be needed while the bone is healing. People with vitamin D lack due to intestinal problems are best treated with the injections.

Most people with symptoms due to osteomalacia report an improvement in the pain about two weeks after the injection.

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Ó NHS Tayside; 2006; version 1.0

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