BPSU - Nutritional Rickets presenting to secondary care in children and young people under the age of sixteen in the UK and ROI

Surveillance of nutritional rickets presenting to secondary care in children and young people under the age of 16 began in March 2015. The study team hopes to ascertain the incidence of nutritional rickets and presentational features of the condition.

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Lead investigators

Prof Mitch Blair

Prof Mitch Blair
Northwick Park Hospital
Watford Road
Dr Priscilla Julies
Royal Free Hospital
Pond Street

Email: p.julies@nhs.net


Rickets is unique to growing children and adolescents and occurs when growing bones do not develop adequately. As a result the child’s bones soften which can lead to distressing short-term (e.g. pain, delayed walking) and sometimes long-term consequences (e.g. deformed limbs needing surgical correction, difficulty with child-bearing).

Rickets is the commonest childhood complication of vitamin D deficiency (VDD) and is caused by a lack of dietary calcium or problems with the supply, metabolism or utilisation of vitamin D. The disease can be recognised in children and adolescents by specific clinical signs and/or bone x-rays.

There is little data on the number of rickets cases in the UK with the last national UK survey of rickets conducted in 1945. The limited data available to date shows that VDD in the UK is steadily increasing.

This study will investigate the incidence of nutritional rickets in children under the age of 16 presenting to secondary care in the UK and Republic of Ireland. The study will also identify and describe the characteristics and clinical management of these affected children.

Case definition

Please report any cases of children 0-16 years in the past month presenting with either clinical or radiological rickets as defined below. Please report all new suspected cases, even if the results are pending.

Clinical rickets with any of the following: 

  • Leg deformity(bowing or knock knees)/Swollen wrists or knees or ribs (Rachitic Rosary) AND 250H vitamin D <25nmol/L with one or more abnormalities of serum calcium, alkaline phosphatase, phosphate, parathyroid hormone.


Radiological rickets with: 

  • Widening, cupping, splaying of metaphysis (of any long bone) AND 25OHVitamin D <25nmol/L

Exclusion criteria

  • Vitamin D dependent rickets e.g.  1α-hydroxylase deficiency - vitamin D resistant rickets e.g. familial or X-linked hypophosphataemic rickets
  • Rickets associated with other chronic diseases e.g. malabsorption, liver disease, chronic renal disease
  • Metabolic Bone Disease of Prematurity (infants whose corrected age is < 3 months at presentation, who were born < 36 weeks gestation and weighing <1.5kg) 


March 2015 to March 2017 (26 months of surveillance).


This study is being funded through an unrestricted educational grant from Nutricia  through the research grant committee of the Royal National Orthopaedic Hospital.

Ethical approval

This study has been approved by NRES Committee London - West London & GTAC (REC reference: 14/LO/2221; IRAS ID: 144785)

Support group

Further information


Logos of: Royal Free London NHS Foundation Trust, BPSU, RCPCH