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Prevention of rickets and osteomalacia in the UK: political action overdue
  1. Suma Uday1,2,
  2. Wolfgang Högler1,2
  1. 1Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
  2. 2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Wolfgang Högler, Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; wolfgang.hogler{at}


The consequences of vitamin D and dietary calcium deficiency have become a huge public health concern in the UK. The burden of disease from these deficiencies includes rickets, and hypocalcaemic seizures, dilated cardiomyopathy and mostly occult myopathy and osteomalacia. The increasing burden of the disease is intrinsically linked to ethnicity and the population demographic changes in the UK. Three facts have led to the resurfacing of the English disease: (1) the UK has no ultraviolet sunlight for at least 6 months of the year, (2) dark skin produces far less vitamin D than white skin per unit ultraviolet light exposure, and (3) non-European Union immigration over the last century. To date, the UK government demonstrates incomplete understanding of these three facts, and its failure to adjust its prevention programmes to changing demographics is endangering the health and life of UK residents with dark skin, of whom infants are the most vulnerable. Establishing accountability through the implementation of monitored antenatal and infantile supplementation programmes and mandatory food fortification is overdue.

  • immigration
  • dark skin
  • South Asian
  • African
  • vitamin D deficiency

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  • Contributors SU: preparation of the manuscript and final approval. WH: concept, intellectual revision and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.