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Review
. 2017 Aug;15(4):293-302.
doi: 10.1007/s11914-017-0383-y.

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Suma Uday  1 , Wolfgang Högler  2   3
Affiliations
Review

Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies

Suma Uday et al. Curr Osteoporos Rep. 2017 Aug.

Erratum in

Abstract

Purpose of review: Nutritional rickets and osteomalacia are common in dark-skinned and migrant populations. Their global incidence is rising due to changing population demographics, failing prevention policies and missing implementation strategies. The calcium deprivation spectrum has hypocalcaemic (seizures, tetany and dilated cardiomyopathy) and late hypophosphataemic (rickets, osteomalacia and muscle weakness) complications. This article reviews sustainable prevention strategies and identifies areas for future research.

Recent findings: The global rickets consensus recognises the equal contribution of vitamin D and dietary calcium in the causation of calcium deprivation and provides a three stage categorisation for sufficiency, insufficiency and deficiency. For rickets prevention, 400 IU daily is recommended for all infants from birth and 600 IU in pregnancy, alongside monitoring in antenatal and child health surveillance programmes. High-risk populations require lifelong supplementation and food fortification with vitamin D or calcium. Future research should identify the true prevalence of rickets and osteomalacia, their role in bone fragility and infant mortality, and best screening and public health prevention tools.

Keywords: Dietary calcium; Food fortification; Nutritional rickets; Osteomalacia; Supplementation policy; Vitamin D.

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Conflict of interest statement

Wolfgang Högler and Suma Uday declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Stages of calcium deprivation leading to nutritional rickets and osteomalacia
See this image and copyright information in PMC

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