Osteomalacia and rickets (vitamin D deficiency)

Written by Dr Colin Paterson, consultant physician

What are osteomalacia and rickets?

These are disorders caused by insufficient levels of vitamin D in the body. They are really the same condition; rickets is the name used when it occurs in children whereas osteomalacia is the term used for adults.

Where do we get vitamin D from?

There are two sources of vitamin D:

a person's diet

formation in the skin through exposure to sunlight.

There are few dietary sources of vitamin D. The best ones are fatty fish such as salmon and sardines, and margarines supplemented with vitamin D.

Milk contains added vitamin D in the USA but not in the UK. Most people in the UK get most of their vitamin D from exposure of the skin to sunlight.

The average person has enough vitamin D stored in their body to last for two or three years.

Who is at risk of vitamin D deficiency?

People who get little exposure to sunlight are most at risk of vitamin D deficiency in the UK. Immigrants from Asia, particularly women and children, are at risk, as are elderly people who are housebound or confined to residential and nursing homes.

Some people with intestinal problems such as Crohn's disease and coeliac disease may also become short of vitamin D.

What are the symptoms of osteomalacia and rickets?

Osteomalacia: widespread bone pains and sometimes muscle weakness. Fractures can occur.

Rickets: aches and pains, and sometimes visible enlargement of bones at joints, such as the wrists.

How do we test for vitamin D deficiency?

Blood tests are most helpful in identifying osteomalacia in adults 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.

What treatment is available?

Regular daily supplements of vitamin D and calcium, eg Calcichew D3 or Adcal D3, are usually used for people with simple vitamin D deficiency, but some people have a single injection vitamin D, in the form of calciferol (vitamin D2). This is stored in the body and can last up to a year before another injection may be needed.

People with vitamin D deficiency due to intestinal problems are best treated with calciferol. Most people with osteomalacia find their pain is reduced about two weeks after the injection. Extra calcium may also be needed while bone is healing.

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