British Paediatric and Adolescent Bone Group’s position statement on vitamin D deficiencyBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8182 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8182
- Paul Arundel, consultant in paediatric metabolic bone disease and secretary, British Paediatric and Adolescent Bone Group1,
- S F Ahmed, Samson Gemmell chair of child health2,
- J Allgrove, consultant paediatric endocrinologist3,
- N J Bishop, professor of paediatric bone disease4,
- C P Burren, consultant paediatric endocrinologist and diabetologist5,
- B Jacobs, consultant paediatrician6,
- M Z Mughal, consultant in paediatric bone disorders7,
- A C Offiah, HEFCE clinical senior lecturer8,
- N J Shaw, consultant paediatric endocrinologist9
- 1Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK
- 2School of Medicine, University of Glasgow, Glasgow, UK
- 3Great Ormond Street Hospital, London. UK
- 4Academic Unit of Child Health, University of Sheffield, Sheffield, UK
- 5Bristol Royal Hospital for Children, Bristol, UK
- 6Royal National Orthopaedic Hospital, Stanmore, UK
- 7Royal Manchester Children’s Hospital, Manchester, UK
- 8Academic Unit of Child Health, University of Sheffield, Sheffield, UK
- 9Birmingham Children’s Hospital, Birmingham, UK
Because of the lack of well designed studies on vitamin D and health,1 the British Paediatric and Adolescent Bone Group has produced a position statement based on current expert opinion. This statement is supported by the British Society of Paediatric Radiology and child protection and nutrition committees of the Royal College of Paediatrics and Child Health.
There is currently considerable clinical and research interest in vitamin D deficiency. Definitions of a sufficient vitamin D concentration vary across clinical guidelines. This causes confusion and may influence clinical decision making in children and adolescents.
The British Paediatric and Adolescent Bone Group’s current opinion is that the definition of vitamin D deficiency should relate only to vitamin D’s effect on the skeleton. Deficiency should be a plasma concentration of 25 hydroxyvitamin D of less than 25 nmol/L (10 ng/mL), with insufficiency being 25-50 nmol/L and sufficiency a concentration greater than 50 nmol/L. We generally use these thresholds in practice, although we recognise that the evidence base in children and adolescents is limited.
In infants with unexplained fractures, unless conventional radiography and biochemistry (abnormal blood concentrations of calcium, phosphate, alkaline phosphatase, or parathyroid hormone) provide evidence of rickets, 25 hydroxyvitamin D is not implicated.
It is important that people at risk of vitamin D deficiency take vitamin D supplements, as recommended by the chief medical officers for the UK.2 These include all pregnant or breastfeeding women and all infants and children from the age of 6 months to 5 years. We also recommend that exclusively breastfed infants receive vitamin D supplements from soon after birth.
Cite this as: BMJ 2012;345:e8182
Competing interests: None declared.