Incidence of vitamin D deficiency rickets among Australian children: an Australian Paediatric Surveillance Unit study

Craig F. Munns, Peter J. Simm, Christine P. Rodda, Sarah P. Garnett, Margaret R. Zacharin, Leanne M. Ward, Janet Geddes, Sarah Cherian, Yvonne Zurynski, Christopher T. Cowell, APSU Vitamin D Study Group

Research output: Contribution to journalArticlepeer-review

100 Citations (Scopus)


Objective: To determine the incidence of and factors associated with vitamin D deficiency rickets in Australian children. Design: 18-month questionnaire-based prospective observational study, using Australian Paediatric Surveillance Unit (APSU) data. Setting: Australian paediatricians and child health workers, January 2006 - July 2007. Participants: Children aged ≤ 15 years with vitamin D deficiency rickets (25-hydroxyvitamin D [25OHD] ≤ 50nmol/L, and elevated alkaline phosphatase levels [> 229 IU/L] and/or radiological rickets). Main outcome measures: Incidence of vitamin D deficiency rickets. Description of demographics, clinical presentation, identification and further analysis of overrepresented groups, and treatment regimens compared with best-practice guidelines. Results: We identified 398 children with vitamin D deficiency (55% male; median age, 6.3 years [range, 0.2-15 years]). The overall incidence in children ≤ 15 years of age in Australia was 4.9/100 000/year. All had a low 25OHD level (median, 28 nmol/L [range, 5-50nmol]) and an elevated alkaline phosphatase level (median, 407 IU/L [range, 229-5443 IU/L]), and 48 (12%) were hypocalcaemic. Ninety-five children had wrist x-rays, of whom 67 (71%) had rachitic changes. Most (98%) had dark or intermediate skin colour and 18% of girls were partially or completely veiled. Most children were born in Africa (252; 63%) and 75% of children were refugees. Duration of exclusive breastfeeding was inversely related to serum vitamin D levels in children < 3 years of age. Empirical vitamin D treatment was given to 4% of children before diagnosis. Conclusions: Vitamin D deficiency rickets is a significant problem in Australia among known high-risk groups. Public health campaigns to prevent, identify and treat vitamin D deficiency, especially in high-risk groups, are essential.

Original languageEnglish
Pages (from-to)466-468
Number of pages3
JournalMedical Journal of Australia
Issue number7
Publication statusPublished - 16 Apr 2012
Externally publishedYes


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