Global consensus on nutritional rickets: Implications for Australia

Aris Siafarikas^{1

2

3

4}, Peter Simm^{5

6

7}, Margaret Zacharin^{5

6

7}, Craig Jefferies^{8

9}, Antony R Lafferty^{10

11}, Benjamin J Wheeler¹², Elaine Tham¹³, Justin Brown^{14

15}, Andrew Biggin^{16

17}, Paul Hofman⁹, Helen Woodhead^{18

19

20}, Christine Rodda^{7

21

22}, Diane Jensen^{23

24}, Denise Brookes²⁵, Craig F Munns^{16

26}; APEG Bone and Mineral Working Group

Affiliations

¹ Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.
² Telethon Kids Institute for Child Health Research and Division of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia, Australia.
³ Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
⁴ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Perth, Western Australia, Australia.
⁵ Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁸ Starship Children's Health, Auckland, New Zealand.
⁹ Liggins Institute, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
¹¹ Paediatrics and Child Health, ANU Medical School, Canberra, Australian Capital Territory, Australia.
¹² Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
¹³ Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹⁴ Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
¹⁵ Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Melbourne, Victoria, Australia.
¹⁶ Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Sydney, New South Wales, Australia.
¹⁷ Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Sydney Children's Hospital, Sydney, New South Wales, Australia.
¹⁹ Royal North Shore Hospital, Sydney, New South Wales, Australia.
²⁰ School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia.
²¹ North West Academic Centre, AIMSS, The University of Melbourne, Melbourne, Victoria, Australia.
²² Western Centre for Health Research and Education Western Health Sunshine Hospital, Melbourne, Victoria, Australia.
²³ Children's Health Queensland, Hospital and Health Services District, Brisbane, Queensland, Australia.
²⁴ Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia.
²⁵ QUT Centre for Children's Health Research, Brisbane, Queensland, Australia.
²⁶ Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 32567782
DOI: 10.1111/jpc.14941

Global consensus on nutritional rickets: Implications for Australia

Aris Siafarikas et al. J Paediatr Child Health. 2020 Jun.

. 2020 Jun;56(6):841-846.

doi: 10.1111/jpc.14941.

Authors

Affiliations

¹ Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.
² Telethon Kids Institute for Child Health Research and Division of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia, Australia.
³ Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
⁴ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Perth, Western Australia, Australia.
⁵ Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁸ Starship Children's Health, Auckland, New Zealand.
⁹ Liggins Institute, University of Auckland, Auckland, New Zealand.
¹⁰ Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
¹¹ Paediatrics and Child Health, ANU Medical School, Canberra, Australian Capital Territory, Australia.
¹² Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
¹³ Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹⁴ Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
¹⁵ Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Melbourne, Victoria, Australia.
¹⁶ Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Sydney, New South Wales, Australia.
¹⁷ Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Sydney Children's Hospital, Sydney, New South Wales, Australia.
¹⁹ Royal North Shore Hospital, Sydney, New South Wales, Australia.
²⁰ School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia.
²¹ North West Academic Centre, AIMSS, The University of Melbourne, Melbourne, Victoria, Australia.
²² Western Centre for Health Research and Education Western Health Sunshine Hospital, Melbourne, Victoria, Australia.
²³ Children's Health Queensland, Hospital and Health Services District, Brisbane, Queensland, Australia.
²⁴ Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia.
²⁵ QUT Centre for Children's Health Research, Brisbane, Queensland, Australia.
²⁶ Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 32567782
DOI: 10.1111/jpc.14941

Abstract

In 2016, a global consensus on the prevention, diagnosis and management of nutritional rickets was published. The bone and mineral working group of the Australasian Paediatric Endocrine Group provides a summary and highlights differences to previous Australian and New Zealand (ANZ) guidelines on vitamin D deficiency and their implications for clinicians. Key points are: (i) The International Consensus document is focused on nutritional rickets, whereas the ANZ guidelines were focused on vitamin D deficiency. (ii) Definitions for the interpretation of 25-hydroxy vitamin D (25OHD) levels do not differ between statements. (iii) The global consensus recommends that routine 25OHD screening should not be performed in healthy children and recommendations for vitamin D supplementation are not based solely on 25OHD levels. The Australasian Paediatric Endocrine Group bone and mineral working group supports that screening for vitamin D deficiency should be restricted to populations at risk. (iv) Recommendations from the global consensus for vitamin D dosages for the therapy of nutritional rickets (diagnosed based on history, physical examination, biochemical testing and a confirmation by X-rays) are higher than in ANZ publications. (v) The global consensus recommends the implementation of public health strategies such as universal supplementation with vitamin D from birth to 1 year of age and food fortification. We conclude that updated global recommendations for therapy of nutritional rickets complement previously published position statements for Australia and New Zealand. Screening, management and the implementation of public health strategies need to be further explored for Australia.

Keywords: endocrinology; general paediatrics; vitamin D supplementation.

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References

1. Munns CF, Shaw N, Kiely Met al. Global consensus recommendations on prevention and management of nutritional rickets. J. Clin. Endocrinol. Metab. 2016; 101: 394-415.
1. Paxton GA, Teale GR, Nowson CAet al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: A position statement. Med. J. Aust. 2013; 198: 142-3.
1. Nowson CA, McGrath JJ, Ebeling PRet al. Vitamin D and health in adults in Australia and New Zealand: A position statement. Med. J. Aust. 2012; 196: 686-7.
1. Swiglo BA, Murad MH, Schunemann HJet al. A case for clarity, consistency, and helpfulness: State-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J. Clin. Endocrinol. Metab. 2008; 93: 666-73.
1. National Health and Medical Research Council. Procedures and Requirements for Meeting the 2011 NHMRC Standard for Clinical Practice Guidelines - Summary for Developers. Canberra, ACT. 2011.

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Global consensus on nutritional rickets: Implications for Australia

Affiliations

Global consensus on nutritional rickets: Implications for Australia

Authors

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Abstract

References

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Medical