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Nutritional rickets in Norway: a nationwide register-based cohort study
  1. Haakon E Meyer1,2,
  2. Kristina Skram3,
  3. Ingvill Almås Berge3,
  4. Ahmed A Madar1,
  5. Hilde Johanne Bjørndalen3
  1. 1Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
  2. 2Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
  3. 3Department of Pediatrics, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Professor Haakon E Meyer; haakon.meyer{at}


Objectives Poor vitamin D status has been reported to be highly prevalent in many non-western immigrant groups living in Norway and other western countries. However, data on rickets are scarce, and the aim of the current study was to identify new cases of nutritional rickets in Norway in the period 2008–2012 among children under the age of 5 years.

Design Register-based cohort study.

Setting The Norwegian population from 2008 to 2012.

Participants Children with nutritional rickets under the age of 5 years.

Main outcome measure Nutritional rickets. Patients with ICD10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) diagnosis code E55.0 (active rickets) treated at all Norwegian hospitals were identified in the Norwegian Patient Registry. We were able to review 85% of the medical records for diagnosis confirmation. In addition, we identified patients with the diagnoses E55.9, E64.3 and E83.3 to identify individuals with rickets who had been given other diagnoses.

Results Nutritional rickets was confirmed in 39 children aged 0–4 years with the diagnosis of E55.0. In addition, three patients with the diagnosis of unspecified vitamin D deficiency (E55.9) were classified as having nutritional rickets, giving a total of 42 patients. Mean age at diagnosis was 1.40 years (range 0.1–3.5 years), and 93% had a non-western immigrant background. The incidence rate of rickets was estimated to be 0.3 per 10 000 person-years in the total Norwegian child population under the age of 5 years and 3.1 per 10 000 person-years in those with an immigrant background from Asia or Africa.

Conclusion The number of children with nutritional rickets in Norway remained low in the period 2008–2012. Nearly all children had a non-western immigrant background.

  • rickets
  • immigrant
  • vitamin D
  • nutrition

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  • Transparency declaration The lead author (HEM) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Contributors HEM, IAB, AAM and HJB conceived the study. HEM, KS, IAB and HJB collected the data. HEM analysed the data and drafted the article. All authors contributed in the interpretation of the findings, critically revised the paper for important intellectual content and approved the final version. HEM is the guarantor.

  • Funding This study was funded by the Norwegian Directorate of Health. The sponsor had no influence on the preparation, review or approval of the manuscript.

  • Competing interests None declared.

  • Ethics approval The study did not include any involvement from the patients and was approved by the Regional Committee for Medical and Health Research Ethics (2013/2370/REK sør-øst D).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Regional Committee for Medical and Health Research Ethics judged these data to be highly sensitive. The data can therefore not be shared unless a separate query is sent to the ethical committee and the data owners.

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