VITAMIN D DEFICIENCY RICKETS IN AUSTRALIAN CHILDREN: APSU UPDATE
Munns C1, Zacharin M2, Rodda C3, Davis E4, Harris M5, Batch J6, Pascoe M7, Fairchild J8, Lafferty A9,
Whybourne A10, Ward L11, Morley R12, Garnett S13, Burgner D14, Geddes J14, Cherian S14, Zurinski Y15,
McKay N15, Cowell C1.
The Children's Hospital at Westmead, Sydney, and University of Sydney, NSW; 2Department of
Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne; 3Paediatric Endocrinology and Diabetes,
Monash Medical Centre, Melbourne; 4Department Endocrinology & Diabetes, Princess Margaret Hospital for
Children, Perth, WA; 5Department of Endocrinology and Diabetes, Mater Children’s Hospital, Brisbane,
Queensland; 6Department of Endocrinology and Diabetes, The Royal Children’s Hospital, Brisbane, Qld;
Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania; 8Department of Endocrinology and
Diabetes, Women and Children’s Hospital, Adelaide, SA; 9Department of Paediatrics, Canberra Hospital,
Woden Valley, ACT; 10Royal Darwin Hospital, Darwin, NT; 11University of Ottawa, Children’s Hospital of
Eastern Ontario, Ottawa, ON, Canada; 12University of Melbourne and Murdoch Children’s Research Institute,
Melbourne, Vic; 13Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, NSW;
Department of Paediatrics, Princess Margaret Hospital for Children, Perth, WA; 15Australian Paediatric
Surveillance Unit, The Children's Hospital at Westmead, Sydney NSW.
Introduction: The major source of Vitamin D in Australia is skin exposure to UVB. Vitamin D is critical for
calcium homeostasis and skeletal mineralization. Simple vitamin D deficiency (SVDD) leads to rickets and
osteomalacia and is associated with pain, fractures, skeletal deformity, growth retardation, dental enamel
defects, delayed developmental milestones and, in severe cases, hypocalcaemic tetany and seizures1. Here
we report the preliminary data of an Australian Paediatric Surveillance Unit (APSU) study to assess the
incidence of and risk factors for SVDD in Australia
Method Design: Prospective Australia wide questionnaire based study in conjunction with the APSU. SVDD
was defined as reduced concentration of 25-hydroxy vitamin D and elevated alkaline phosphatase or
Results: In the 8 months from January 2006, 187 notifications of SVDD were made, with 44 confirmed
cases. Mean age at diagnosis 7.3 yrs±5.0. Presenting features included bone pain 36%, poor growth 22%,
limb deformity 11% and hypotonia 11%. Eighty-two precent of cases had dark skin. Fifty-nine percent of
cases were born outside Australia (Sudan 30%, Egypt 14%, 15% other). All but one of the mothers was born
outside Australia and 93% were veiled for cultural or religious reasons.
Conclusion: These preliminary data confirm that SVDD in Australia is associated with significant morbidity
and its incidence is highest amongst recent migrants to Australia and those with darker skin colour. If
confirmed, this will have to be addressed through public health campaigns that incorporate all levels of
government and the health care system.
1. Munns C, et al. Med J Aust. 2006 4;185(5):268-72.