Rickets caused by vitamin D deficiency
Vitamin D deficiency is increasing in the general community, and nutritional rickets is re-emerging as a significant health concern for children. See Who should have their vitamin D measured for information about risk factors for vitamin D deficiency. A consensus statement on preventing and treating nutritional rickets was published in 20161. Rickets caused by vitamin D deficiency should be managed with specialist advice.
Vitamin D supplementation reduces bone pain and increases muscle strength within weeks. To treat vitamin D deficiency causing rickets, use:
colecalciferol rickets
neonate : 25 micrograms (1000 international units) orally, daily for 3 months
child 1 to 12 months: 75 micrograms (3000 international units) orally, daily for 3 months
child more than 12 months: 125 micrograms (5000 international units) orally, daily for 3 months.
Megadose therapy can be considered to improve adherence. For megadose therapy in a child older than 12 months, use:
colecalciferol 3750 micrograms (150 000 international units) orally, as a single dose. Dose can be repeated every 4 to 6 weeks if required.
Use a smaller dose for children between 3 and 12 months—seek expert advice. Megadose therapy is not recommended in children less than 3 months of age.
Long-term supplementation is usually needed unless risk factors change substantially. A suitable long-term maintenance dose is:
colecalciferol 10 micrograms (400 international units) orally, daily.
Some patients require a higher maintenance dose. Consider supplemental calcium in patients treated for vitamin D deficiency if dietary calcium intake is inadequate.