In the final instalment of our weekly feature Sasa Jovenic details the opportunities for further care and a case study from a rickets clinic.

Opportunities for further care

Pointing out the risks of vitamin D deficiency is one thing you can do to help your customers, but Dr Tom Margham, a GP at Jubilee Street Practice in Tower Hamlets and also primary care lead at charity Arthritis Research UK, stresses that this can also open up opportunities for continuing care.

“In general, any treatment needs to ask why the deficiency was happening in the first place, and address the underlying cause,” he says.

“If you see a prescription for a loading dose [to treat a deficiency] then that should get their levels up to normal and then you can talk about how to maintain the levels, especially over the winter months.

“If someone is complaining of musculoskeletal pain, for example, advise them to take a lower strength dose but to talk to their GP about the loading dose.

"Don’t forget, also, that there is quite a high level of awareness in different ethnic groups about the risk of vitamin D deficiency, so be prepared to be asked if vitamin D supplements are Halal, and have the right stuff in stock.”

Vitamin D deficiency is very simple to test for, but once someone has been diagnosed there is a lot that community pharmacy can do to help them on the road to recovery.


Dr Benjamin Jacobs is consultant paediatrician and director of children’s service at the Royal National Orthopaedic Hospital in Stanmore, and a member of the Royal College of Paediatrics and Child Health.

He says: “About a year ago I treated a child who had initially presented to another hospital and was then referred to us as I run a rickets clinic.

"The family had been concerned about his legs for a year, but their GP told them they were normal, then sent him to physio, but nobody asked them if he was having vitamin D or about his diet.

"When he came to us and I found out he was still being breastfed at two years old.

"I predicted he might have rickets, and X-rays and blood tests confirmed it.

"We encouraged the mother to continue breastfeeding but also to give him calcium and vitamin D, and now the child is dramatically better and all will be well. However, this cost the NHS a lot and could have been avoided if the baby had had supplements from the start.”