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Paediatr Int Child Health. 2017 May;37(2):84-98. doi: 10.1080/20469047.2016.1248170. Epub 2016 Dec 6.

Nutritional rickets around the world: an update.

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a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA.
b Department of Family Medicine , Mayo Clinic , Rochester , MN , USA.
c Wits/SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics , University of the Witwatersrand , Johannesburg , South Africa.
d Pharmacy Practice, Department of Public Health , North Dakota State University , Fargo , ND , USA.


Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets.


Calcium; Children; Global health; Infants; Osteomalacia; Rickets; Vitamin D

[Indexed for MEDLINE]

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