Nutritional rickets and vitamin D deficiency: consequences and strategies for treatment and prevention
Issued Date
2022-01-01
Resource Type
ISSN
17446651
eISSN
17448417
Scopus ID
2-s2.0-85134232468
Pubmed ID
35852141
Journal Title
Expert Review of Endocrinology and Metabolism
Volume
17
Issue
4
Start Page
351
End Page
364
Rights Holder(s)
SCOPUS
Bibliographic Citation
Expert Review of Endocrinology and Metabolism Vol.17 No.4 (2022) , 351-364
Suggested Citation
Charoenngam N. Nutritional rickets and vitamin D deficiency: consequences and strategies for treatment and prevention. Expert Review of Endocrinology and Metabolism Vol.17 No.4 (2022) , 351-364. 364. doi:10.1080/17446651.2022.2099374 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86333
Title
Nutritional rickets and vitamin D deficiency: consequences and strategies for treatment and prevention
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Introduction: Rickets is typically characterized by bone deformities due to defective bone mineralization and chondrocyte maturation in growing bones. However, infantile rickets often goes unrecognized, because the skeletal abnormalities are more subtle and often can only be detected radiologically. Nutritional rickets is a major public health concern in several regions worldwide. It is most commonly caused by vitamin D and/or calcium deficiency. Area covered: We provide an overview of historical perspective, epidemiology, and pathophysiology of nutritional rickets. Additionally, we outline diagnostic approaches and highlight challenges in radiographic diagnosis of rickets. Finally, we present strategies for prevention and treatment of rickets. Expert opinion: Despite the evidence from clinical databases that rickets is a rare disease, it is likely that rickets is clinically underdiagnosed as studies designed to screen healthy children for radiographic evidence of rickets reported surprisingly much higher prevalence. It has been reported that some of the radiologic features of rickets can be misinterpreted as fractures. To prevent nutritional rickets, most if not all infants and young children, should receive vitamin D from formulas and foods that are fortified with vitamin D or supplementation to achieve a serum 25-hydroxyvitamin D of at least 20 ng/mL as recommended by the Institute of Medicine. It has been recommended by the Endocrine Society that to achieve maximum bone health for children and adults, a serum concentration of 25-hydroxyvitamin D should be at least 30 ng/mL and preferably 40–60 ng/mL. Pregnant women who are unable to obtain an adequate amount of vitamin D from sunlight exposure and natural and fortified diets should take a vitamin D supplement of 1500–2000 IUs daily as recommended by the Endocrine Society since it has been demonstrated that 600 IUs daily will not maintain a circulating 25-hydroxyvitamin D of at least 20 ng/mL and most pregnant women. If lactating women take approximately 6400 IUs of vitamin D daily, they provide enough vitamin D in their milk to satisfy their infant’s requirement thereby preventing rickets.