Rickets: new insights into a re-emerging problem

Abstract

Rickets is a disease that has plagued communities for centuries. Once thought of as a disease that was left behind in the industrial revolution of the nineteenth century, nutritional rickets is re-emerging as a problem in Western Europe and the US. Reduction in vitamin D and calcium intake in children's diets along with migration of culturally vulnerable groups to more temperate climates have increased, predisposing large populations to vitamin D deficiency and rickets. Recent evidence suggests that vitamin D deficiency during pregnancy may have both an immediate and longer-term deleterious effect on children. Focus on hypophosphataemic rickets has identified FGF23 as the phosphaturic factor central to renal phosphate loss. Mutations in the dentin matrix protein-1 gene have been implicated in autosomal recessive hypophosphataemic rickets. Rickets is the most common form of metabolic bone disease worldwide. Measures such as adequate sunlight exposure and dietary supplementation are simple but effective in reducing rickets. It is important to target culturally vulnerable groups and pregnant women. Preterm babies form a specific population that is particularly vulnerable to the metabolic consequences of calcium and phosphate deficiency, requiring early intervention.