Alaska Native children under 10 had double the national rickets rate during 2001–2010, state report shows

Alaska Native children under 10 experienced nearly double the national rickets rate during 2001–2010, with incidence climbing sharply at higher latitudes, according to a 2017 Alaska Division of Public Health report.

During that decade, Alaska Native children had an average annual rickets-associated hospitalization rate of 2.23 cases per 100,000, compared to 1.23 per 100,000 for the general U.S. pediatric population. The incidence increased 2.3-fold for every 4 degrees of latitude within Alaska.

Of 16 confirmed rickets cases among Alaska Native children during 1999 to 2013, 10 cases were in infants. Cord blood samples from the Yukon-Kuskokwim Delta showed widespread deficiency: 91 percent of 78 cord blood samples collected during 2001 to 2010 had vitamin D concentrations below 50 nanomoles per liter.

The report identified northern latitude, skin pigmentation, lack of vitamin D supplementation, breastfeeding without supplementation, and the shift away from traditional diets as key risk factors.

Supplementation guidance

These findings helped inform the 2018 Alaska Vitamin D Workgroup recommendations. The workgroup advised clinicians to consider prescribing 800 IU per day of vitamin D for exclusively or partially breastfed infants in Alaska. That is double the 400 IU per day minimum in national guidelines.

For pregnant women living in Alaska, the Workgroup recommended clinicians consider supplementing with 1,000 IU per day of vitamin D in addition to a daily prenatal vitamin containing 400 IU, for a total of about 1,400 IU per day.

Alaska Medicaid covers vitamin D supplementation of up to 800 IU per day for infants and 1,000 IU per day for pregnant women.