BPSU study - Nutritional rickets

Surveillance of nutritional rickets presenting to secondary care in children and young people concluded in March 2017. The study team hoped to ascertain the incidence of nutritional rickets and presentational features of the condition.

The study group has now published its findings in the Archives of Disease in Childhood. A link to the abstracts can be found below.

Lead investigators

Professor Mitch Blair
Northwick Park Hospital
Watford Road
Harrow HA1 3UJ

Dr Priscilla Julies
Royal Free Hospital
Pond Street
London NW3 2QG
Email: p.julies@nhs.net

About the study


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 (eg pain, delayed walking) and sometimes long-term consequences (eg deformed limbs needing surgical correction, difficulty with child-bearing).

Rickets is the most common 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 investigated 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 also identified and described the characteristics and clinical management of these affected children.

You can download the protocol card, including references, below.

Case definition

Any cases of children 0-16 years in the past month presenting with either clinical or radiological rickets as defined below including 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 25OH Vitamin 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).


Published papers


March 2015 to March 2017 (25 months of surveillance).


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


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

Support group