Rickets is still with us: What GPs need to know about vitamin D, calcium and early intervention

Prof Craig Munns

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Prof Craig Munns

Paediatric Endocrinologist; Queensland Children's Hospital

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Prof Craig Munns

While interest in vitamin D frequently focuses on its possible effects on immunity, allergy and chronic disease, the strongest evidence relates to its critical role in calcium absorption, skeletal development and the prevention of nutritional rickets.

Despite Australia’s sunny climate, vitamin D deficiency is common in pregnancy. One recent Australian study1, conducted in Western Australia, found approximately one in five pregnant women were vitamin D deficient, with the youngest women most likely to be deficient.

Understanding who is most at risk, and when and how to intervene, can significantly improve outcomes for both mothers and children.

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References

  1. Miller KM, et al. Aust N Z J Public Health. 2021;45(5):474-81.
  2. Munns CF, et al. J Clin Endocrinol Metab. 2016;101(2):394-415.
  3. Bouillon R, et al. Endocr Rev. 2019;40(4):1109-51.
  4. Institute of Medicine of the National Academies. (2011). Dietary Reference Intakes for Calcium and Vitamin D. Available from: https://www.nationalacademies.org/projects/FNBX-H-08-08-A/publication/13050. Accessed July 30, 2026.
  5. Paxton GA, et al. Med J Aust. 2013;198(3):142-3.
  6. Hollis BW, et al. J Bone Miner Res. 2011;26(10):2341-57.
  7. Lau SL, et al. Med J Aust. 2011;194(7):334-7.
  8. McLeod DS, et al. Med J Aust. 2011;195(7):384-5.
  9. Perampalam S, et al. Aust N Z J Obstet Gynaecol. 2011;51(4):353-9.
  10. Teale GR, Cunningham CE. Aust N Z J Obstet Gynaecol. 2010;50(3):259-61.
  11. Thomas SD, et al. BMJ Open. 2011;1(2):e000236.
  12. Kovacs CS. Endocrinol Metab Clin North Am. 2011;40(4):795-826.
  13. Munns C, et al. Med J Aust. 2006;185(5):268-72.
  14. Johns Hopkins All Children’s Hospital. (2023). Enteral Vitamin and Mineral Supplementation Clinical Pathway. Available from: https://www.hopkinsmedicine.org/-/media/files/allchildrens/clinical-pathways/enteral-vitamin-and-mineral-supplementation.pdf. Accessed July 31, 2026.
  15. Högler W, Munns CF. Lancet Glob Health. 2016;4(4):e229-30.
  16. Carpenter TO, et al. Nat Rev Dis Primers. 2017;3:17101.
  17. Moon RJ, et al. Am J Clin Nutr. 2024;120(5):1134-42.
  18. Shen J, et al. BMC Pediatr. 2025;25(1):915.
  19. Zeng R, et al. Clin Exp Allergy. 2023;53(5):511-25.
  20. Silvis K, et al. Pediatr Diabetes. 2019;20(1):86-92.
  21. Zipitis CS, Akobeng AK. Arch Dis Child. 2008;93(6):512-7.

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