It is a disease often associated with Victorian slums and thought to be all but eradicated from modern society. But figures show rickets is on the rise in Scotland, with its prevalence outstripping that in England.
Cases have rocketed by 25 per cent from 354 in 2018 to 442 in 2022, nearly matching the tally of 482 across the whole of England. NHS Greater Glasgow and Clyde recorded 356 cases, with 83 in NHS Lanarkshire.
Rickets is caused by a lack of vitamin D, which is produced in the body through exposure to sunlight – something usually limited to the period between April and September in Scotland. Vitamin D occurs naturally in only a few foods – such as oily fish, liver and egg yolks.
One in six people has permanent very low levels, particularly those with darker skin, which processes sunlight less efficiently.
Rickets is caused by a lack of Vitamin D which only occurs naturally in just a few foods including oily fish, liver, and egg yolks
Recently retired Edinburgh GP Helga Rhein, of the campaign group Scots Need Vitamin D, said: ‘How can this be in a modern, developed country?
‘It is no good blaming poverty – the blame lies with the public health system in Scotland. All we do is tick boxes. There is no effort to educate people as to why vitamin D is so vital for so many areas of health, why deficiency is more common in Scotland and to actually dish out supplements. They are so cheap and readily available.
‘One might say that rickets is as much a symptom of state failure as it is of vitamin D deficiency.’
Vitamin D helps to build strong bones. The link between it and rickets was discovered a century ago and helped put an end to the relatively common sight of children – from both poor and wealthy backgrounds – growing up bow-legged.
The condition is often linked to Victorian times as it was rife in industrial cities where smog blocked out sunlight.
Dr Chris Williams, of the Royal College of General Practitioners Scotland, told the Sunday Times: ‘More needs to be done to protect individuals on low incomes from products that have low nutritional value or that are likely to lead to malnutrition if relied upon instead of healthier alternatives.
‘Vulnerable individuals and communities without sufficient access to fresh, nutritious food due to either affordability or supply issues are at increased risk of suffering from rickets due to an inadequate diet.’
Vitamin D is created in the body through exposure to sunlight which is usually limited in Scotland between April and September
Consultant endocrinologist Dr Richard Quinton said: ‘The Scottish Government advises vulnerable people to take vitamin D supplements but there is no active programme to promote the message in schools, nurseries, GP surgeries or community centres.
‘Pre-school and primary schoolchildren in Scotland are routinely treated with sunscreen during the sunnier months, and these are well known to block vitamin D photosynthesis.’
While parts of England enjoy upwards of 1,500 hours of sun-shine a year, most of Scotland records less than 1,300. Children under three as well as pregnant and breastfeeding women are eligible for free supplements.
A Scottish Government spokesman added: ‘We recognise the health benefits of maintaining adequate vitamin D levels and advise that everyone should consider taking a daily 10-microgramme supplement, particularly over winter months, to help maintain bone and muscle health.’
WHAT IS RICKETS?
Rickets is the failure of children’s cartilage to mineralise, causing bones to bend out of shape.
The adult version – where bones themselves weaken – is known as osteomalacia.
Both are caused by the body failing to fix calcium, a process which requires vitamin D. Children suffering the debilitating condition – which can affect limbs and the spine and prove fatal if severe – were described by doctors in ancient Rome. But it was a defined common disease in Britain by the 17th century.
Medics were curious to note victims tended to be from urban areas rather than rural, and rickets afflicted those from every social standing, including royalty.
Sunshine and cod liver oil were seen to help defeat the condition, but the reason why was only understood when vitamin D was discovered in 1919 as part of the search for a cure.