Materiały źródłowe

• #1

  https://link.springer.com/article/10.1007/s11914-017-0383-y

  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 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.

• #2 Nutritional rickets & osteomalacia: A practical approach to management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/

  The leading causes of rickets and osteomalacia worldwide remain solar vitamin D deficiency and/or nutritional calcium deficiency, collectively termed as nutritional rickets and osteomalacia. […] Vitamin D deficiency rickets is on the rise in the developed countries due to a multitude of factors such as lack of sunlight, lack of food fortification, ineffective supplementation programmes and global migration trends. […] The most vulnerable groups remain the dark-skinned immigrant and resident population of high-latitude countries, infants and pregnant women, in particular. […] Individuals with multiple predisposing factors are naturally at the highest risk of rickets and osteomalacia, such as the dark-skinned immigrants residing in high-latitude countries who retain cultural practices such as whole-body clothing, sun avoidance and a diet restricted in dairy products.

• #3 Rickets – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562285/

  The prevalence of the disease has increased in both developed and developing countries. Yet, generally speaking, the prevalence of rickets is higher in developing counties than in developed countries. African, Middle Eastern, and Asian countries have a wide prevalence rate of 10% to 70%. Historically, the prevalence of rickets in the developed countries significantly decreased following the widespread introduction of dietary vitamin D supplementation, legislation to improve air quality, and recognition of the importance of vitamin D and bone health by the public. In the U.S., vitamin D milk fortification (100 IU/cup) was started in the 1930s. […] The worldwide incidence has been estimated differently per 100,000 in various countries as follows: in Canada, 2.9; in New Zealand, 10.5 among children less than three years while it is 2.2 in the older age group (3-15 years); in Australia, 4.9; in Turkey, 3.8; and in the United Kingdom, 7.5. In the U.S., specifically in Minnesota, there is a substantial increase in the incidence in the last 20 years. The reported incidences in the 1970s, 1980s, 1990s, and 2000s were 0, 2.2, 3.7, and 24.1, respectively. Restricted sunlight (UVB) exposure is one of the reasons for this increasing prevalence. Native Alaskan children are at considerable risk for developing rickets than other U.S. populations. The incidence of the rickets hospitalization rate is the highest in Alaska among all U.S. regions, 2.23/100,000 versus 1.23/ 100,000. The incidence of rickets in Alaska is significantly high because of higher latitudes.

• #4

  https://link.springer.com/article/10.1007/s11914-017-0383-y

  The incidence of nutritional rickets (NR) is rising globally, and hospitalisation is increasing even in high income countries. […] The prevalence of osteomalacia histologically at post-mortem in adult Europeans is as high as 25%. […] Public health research has identified traditional diets low in calcium, dark skin and cultural full body clothing, as the predominant causes of rickets and osteomalacia in sunny parts of the world such as the Indian subcontinent, the Middle East and Africa. […] In developed countries, the prevalence of NR is several hundred-fold higher in dark-skinned immigrants compared to native populations. […] The underlying endemic vitamin D deficiency in these ethnic risk groups is exemplified by a population-based study in Saudi Arabia, demonstrating that 92% of girls and 79% of boys had 25OHD levels below 50 nmol/L.

• #5 Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies | springermedizin.de

  https://www.springermedizin.de/nutritional-rickets-and-osteomalacia-in-the-twenty-first-century/12441620

  The prevalence of osteomalacia histologically at post-mortem in adult Europeans is as high as 25%. […] Public health research has identified traditional diets low in calcium, dark skin and cultural full body clothing, as the predominant causes of rickets and osteomalacia in sunny parts of the world such as the Indian subcontinent, the Middle East and Africa. […] In developed countries, the prevalence of NR is several hundred-fold higher in dark-skinned immigrants compared to native populations. […] NR and osteomalacia are fully preventable. Universal supplementation of infants, supplementing pregnant women, promoting vitamin uptake and also food fortification with vitamin D and calcium to prevent fractures in elderly have been proven cost-effective. […] The true prevalence of NR and osteomalacia across the globe remains unknown. Studies are urgently needed to establish their prevalence at a population level, in particular in areas where such data would matter most for public health, as in Africa, the Indian subcontinent and the Middle East.

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Rickets.aspx

  Rickets represents an important health issue not only in developing countries but also in the developed world. The prominent contributing factors include limited sunlight exposure, increased skin pigmentation, geographical location and decreased dietary intake. […] The Centers for Disease Control and Prevention (CDC) estimation is that 5 of every million children between 6 months and 5 years of age have rickets, with a peak prevalence of vitamin D-deficient rickets between 6 and 18 months of age. The majority of affected children are black or breastfed. […] In North America, rickets is most commonly found in children with relatively more pigmented skin, who are exclusively breastfed. In Europe and Australia, rickets is typically identified in immigrant populations from the Indian subcontinent and the Middle East.

• #7 Nutritional rickets & osteomalacia: A practical approach to management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/

  Vitamin D deficiency rickets is more common in infancy and calcium deficiency rickets is more common in childhood, especially in countries with adequate sunlight, such as India. […] The clinical features of rickets and osteomalacia depend largely on the age of presentation and also the severity and duration of deficiency. […] The most recent prospective nutritional rickets survey in the UK reported the highest incidence in children aged 12-23 months, which correlates with the age group with the lowest reported intake of vitamin D in the UK National diet and Nutritional survey. […] A diagnosis of nutritional rickets/osteomalacia is suspected based on predisposing risk factors, dietary history and clinical presentation, and is established on biochemical markers of vitamin D and/or calcium deficiency.

• #8 Rickets – Wikipedia

  https://en.wikipedia.org/wiki/Rickets

  Rickets occurs relatively commonly in the Middle East, Africa, and Asia. […] In developed countries, rickets is a rare disease (incidence of less than 1 in 200,000). Recently, cases of rickets have been reported among children who are not fed enough vitamin D. […] In 2013/2014 there were fewer than 700 cases in England. In 2019 the number of cases hospitalised was said to be the highest in 50 years.

• #9 Vitamin D Deficiency including Osteomalacia and Rickets

  https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro

  Vitamin D deficiency continues to be common in children and adults. […] The UK National Diet and Nutrition Survey reported low vitamin D status (serum 25-hydroxyvitamin D (25[OH]D) concentrations below 25 nmol/L) from combined results from a four-year rolling programme (2008/2009 to 2011/2012) in 23% of adults aged 19-64 years and 21% of adults aged 65 years and over. […] The same survey reported that 7.5% of children aged 1.5-3 years, 14% of children aged 4-10 years and 22% of children aged 11-18 years had a serum 25(OH)D concentration below 25 nmol/L.

• #10 Nutritional rickets in immigrant and refugee children | Public Health Reviews | Full Text

  https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0018-3

  Nutritional rickets is a bone disease in early childhood resulting in bone pain, delayed motor development, and bending of the bones, caused by vitamin D deficiency and/or inadequate dietary calcium intake. […] The prevalence of nutritional rickets is increasing in high-income countries, largely driven by an influx of immigrant populations. […] We recommend screening all immigrant and refugee children under 5 years of age from these ethnic groups for nutritional rickets, based on clinical features, and confirming the diagnosis with radiographs of the wrists and knees. […] The risk of nutritional rickets will likely continue to increase as the proportion of dark-skinned immigrant and refugee children increases in industrialized countries. […] An increasing incidence of children with rickets has also been documented in the USA.

• #11 Vitamin D Deficiency and Related Disorders: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/128762-overview

  Darker skin interferes with the cutaneous synthesis of vitamin D. A study by Holick and coauthors demonstrated that non-Hispanic Black subjects require 6 times the amount of UV radiation necessary to produce a serum vitamin D concentration similar to that found in non-Hispanic White subjects. The explanation for the increased radiation necessary to increase vitamin D levels is that melanin absorbs UV radiation. […] The decreased efficacy of vitamin D production by darker-pigmented skin explains the higher prevalence of vitamin D insufficiency among darker-skinned adults.

• #12 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Rickets.aspx

  In the United States, nutritional rickets was eradicated in the 1930s after discovering that vitamin D possessed antirachitic properties. However, the disease has made an unfortunate comeback, primarily due to a lack of appreciation that human milk contains very little vitamin D to satisfy the infants requirement. […] Of the genetic causes, X-linked hypophosphatemic rickets is most commonly encountered, with a prevalence of 1 in 20 thousand children. Other genetic causes (such as autosomal dominant and autosomal recessive, or mutations in vitamin D 25-hydroxylase or 1-alpha-hydroxylase enzymes) are exceptionally rare.

• #13 Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

  https://www.orthojournal.org/articles/multiple-diagnoses-of-nutritional-rickets-in-an-inner-city-pediatric-population-a-case-series.html

  The global incidence of nutritional rickets is rising, even in the United States and other high-income countries. Nutritional rickets had largely disappeared from industrialized countries when food fortifications programs were introduced, but there has been a re-emergence over the past two decades. In the US alone, the prevalence of rickets has increased from 0 per 100,000 in 1970 to 3.7 per 100,000 in 1990, and further up to 24.1 per 100,000 in 2000. Although there is a paucity of data on the incidence of this diagnosis in the US alone, the case rate is predicted to be 2.9-27 per 100,000 individuals in the US and Europe as of 2021. […] The prevalence of nutritional rickets is several hundred-fold higher in dark-skinned populations when compared to light-skinned populations. In fact, the likelihood of vitamin D deficiency can range anywhere from 3x-71x higher in these individuals. General risk factors for nutritional rickets include dark skin pigment, children under the age of three who were exclusively breast fed, and low exposure to sunlight.

• #14 Nutritional rickets in immigrant and refugee children | Public Health Reviews | Full Text

  https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0018-3

  The rising incidence of rickets was temporally associated with an increase in dark-skinned (predominantly Somali) immigrants who have settled in Minnesota since 1994. […] Dark skinned races consistently have a higher risk of rickets. […] The burden of vitamin D and dietary calcium deficiency is not limited to children. […] Both rickets and osteomalacia are associated with muscle weakness and hypocalcemic complications. […] Nutritional rickets is common in immigrant and refugee children from the Middle East, Africa, and South Asia. […] Public health policies must address the need for vitamin D supplementation and adequate dietary calcium to protect children from this fully preventable scourge.

• #15 Epidemiology and etiology of osteomalacia – UpToDate

  https://www.uptodate.com/contents/epidemiology-and-etiology-of-osteomalacia

  Epidemiology and etiology of osteomalacia […] There is a growing prevalence of vitamin D deficiency in many countries. Severe and prolonged vitamin D deficiency (25-hydroxyvitamin D <10 ng/mL [25 nmol/L]) can result in hypocalcemia, secondary hyperparathyroidism, secondary hypophosphatemia, and osteomalacia. Nutritional vitamin D deficiency is therefore an increasingly common cause of osteomalacia in adults. Populations at risk include homebound older adults who have little sun exposure and insufficient dietary calcium and vitamin D, patients with malabsorption (eg, related to gastrointestinal bypass surgery, inflammatory bowel disease, or celiac disease), and those with limited sun exposure due to clothing that covers most of the body or restrictions related to skin conditions. Hereditary forms of vitamin D deficiency and resistance, which are identified in childhood, are also associated with osteomalacia in adults, but these disorders are less common.

• #16 Epidemiology and etiology of osteomalacia – UpToDate

  https://www.uptodate.com/contents/epidemiology-and-etiology-of-osteomalacia/print

  There is a growing prevalence of vitamin D deficiency in many countries. Severe and prolonged vitamin D deficiency (25-hydroxyvitamin D <10 ng/mL [25 nmol/L]) can result in hypocalcemia, secondary hyperparathyroidism, secondary hypophosphatemia, and osteomalacia. Nutritional vitamin D deficiency is therefore an increasingly common cause of osteomalacia in adults. Populations at risk include homebound older adults who have little sun exposure and insufficient dietary calcium and vitamin D, patients with malabsorption (eg, related to gastrointestinal bypass surgery, inflammatory bowel disease, or celiac disease), and those with limited sun exposure due to clothing that covers most of the body or restrictions related to skin conditions. Hereditary forms of vitamin D deficiency and resistance, which are identified in childhood, are also associated with osteomalacia in adults, but these disorders are less common.

• #17 Rickets: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/985510-overview

  Rickets is a disease of growing bone that is unique to children and adolescents. It is caused by a failure of osteoid to calcify in a growing person. […] The incidence of rickets in Europe is similar to that in the United States. In sunny areas, such as in the Middle East, rickets may occur when infants are bundled in clothing and are not exposed to sunlight. […] The frequency of rickets has been increasing internationally. Possible reasons include recommendations for children to wear sunscreen while outdoors and a tendency for children to spend more time indoors, watching television or playing electronic games, instead of playing outdoors. […] In the United States, vitamin D deficiency rickets does not generally occur in infants fed proprietary infant formulas, because both formula and cow milk sold in the United States contain 400 IU of vitamin D per liter. Accordingly, except in pediatric patients with chronic malabsorption syndromes or end-stage renal disease, nearly all cases of rickets occur in breastfed infants who have dark skin and receive no vitamin D supplementation.

• #18

  https://link.springer.com/article/10.1007/s11914-017-0383-y

  NR and osteomalacia are fully preventable. Universal supplementation of infants, supplementing pregnant women, promoting vitamin uptake and also food fortification with vitamin D and calcium to prevent fractures in elderly have been proven cost-effective. […] The global consensus recommends the following vitamin D supplements for prevention of NR and osteomalacia: 400 IU daily for all infants regardless of mode of feeding, from birth to a minimum of 12 months of age; 600 IU daily during pregnancy; 600 IU daily lifelong in risk groups. […] The true prevalence of NR and osteomalacia across the globe remains unknown. Studies are urgently needed to establish their prevalence at a population level, in particular in areas where such data would matter most for public health.

• #19 Rickets: Not a Disease of the Past | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0815/p619.html

  Unlike developing countries, the United States saw the eradication of nutritional rickets in the 1930s following the discovery that vitamin D possessed antirachitic properties. Today, in the absence of ongoing national surveillance, it is difficult to know how likely it is that a child with rickets will present to the primary care physician’s office. As a result, the true burden of this condition must be estimated. In one study, the prevalence of nutritional rickets was estimated to be nine cases per 1 million children, whereas the Centers for Disease Control and Prevention places this rate at five cases per 1 million children six months to five years of age. Of note, in multiple studies, most affected children were black.

• #20 Dietary calcium deficiency contributes to the causation of nutritional rickets (NR) in the United Kingdom (UK): data from the British Paediatric Surveillance Unit (BPSU) NR survey | ICCBH2017 | 8th International Conference on Children’s Bone Health |

  https://www.bone-abstracts.org/ba/0006/ba0006p104

  Dietary calcium deficiency contributes to the causation of nutritional rickets (NR) in the United Kingdom (UK): data from the British Paediatric Surveillance Unit (BPSU) NR survey. […] The most common cause of NR in the UK is thought to be secondary to vitamin D deficiency [VDD; serum 25-hydroxyvitamin D (25OHD) 25 nmol/l], although in some African South Asian countries dietary calcium deficiency (DCaD) by itself, or together with VDD is an important cause of NR. […] Currently, the data on new cases of NR is being collected monthly (March 2015-March 2017) from 3500 Paediatricians, using the BPSU reporting methodology. […] Eight cases of NR who did not meet the criteria for VDD (serum 25OHD 25 nmol/l) but had clinical and radiological features of rickets/osteomalacia have been reported to BPSU, during 22 months of surveillance.

• #21 Incidence of vitamin D deficiency rickets among Australian children: an Australian Paediatric Surveillance Unit study | The Medical Journal of Australia

  https://www.mja.com.au/journal/2012/196/7/incidence-vitamin-d-deficiency-rickets-among-australian-children-australian

  Objective: To determine the incidence of and factors associated with vitamin D deficiency rickets in Australian children. […] The overall incidence in children 15 years of age in Australia was 4.9/100 000/year. […] Vitamin D deficiency and associated rickets are re-emerging as major public health issues worldwide, including in Australia. […] Our study aimed to assess vitamin D deficiency with rickets, rather than vitamin D deficiency alone. […] The estimated national annual incidence of vitamin D deficiency rickets among children was 4.9/100 000 children (95% CI, 4.45.4/100 000). […] Most patients (297; 75%) were refugees, and vitamin D deficiency rickets was most commonly detected by abnormal biochemical results on routine screening through refugee clinics. […] This is the first study to assess the incidence of vitamin D deficiency rickets in Australian children.

• #22 Childhood Rickets – New Developments in Epidemiology, Prevention, and Treatment | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/8310/childhood-rickets—new-developments-in-epidemiology-prevention-and-treatment/magazine

  Rickets comprises a group of bone disorders specific to the growing child. […] There remains a need to better understand all forms of rickets, from common causes such as classic vitamin D deficiency rickets to the rarer forms. […] With this Research Topic, we aim to provide a platform for researchers interested in this area to contribute original research studies and review articles on, but not limited to, new developments in not only epidemiology of all forms of childhood rickets, but also exploring pathogenic mechanisms, as well as prevention and treatment.

• #23

  https://www.who.int/publications/i/item/9789241516587

  the magnitude and distribution of nutritional rickets in the population, especially in infants, children and adolescents; […] the causes or determinants of rickets, whether they are biological, behavioural, social or environmental factors; […] potential interventions to prevent or mitigate nutritional rickets in infants, children and adolescents; […] evaluation of the actions for prevention or treatment of nutritional rickets; and […] current research gaps.

• #24 Nutritional rickets – a socioeconomic problem | ICCBH2019 | 9th International Conference on Children’s Bone Health | Bone Abstracts

  https://www.bone-abstracts.org/ba/0007/ba0007is6

  Rickets and osteomalacia are caused by calcium deprivation, meaning the body has insufficient calcium supply and the resulting secondary hyperparathyroidism leads to excessive bone resorption and, via renal phosphate wasting, also to hypomineralization of bone and growth plates. […] On a global scale, hundreds of millions of people are affected, and most are undiagnosed. […] However, rickets and osteomalacia have become a global health concern as they affect humans of all ages whose diets are low in calcium or whose cultural traditions block sunlight. […] Governmental policies and societal/consensus recommendations have very limited effect unless policy is implemented by systematic monitoring of adherence and by providing financial incentives for those delivering the prevention program and for parents attending the child surveillance visits. […] Effective prevention includes provision of calcium-rich food, sunlight exposure and/or vitamin D supplements. […] Since the risk groups for rickets and osteomalacia are easily recognizable, supplementation, not testing, should become the new standard.

• #25

  https://journals.lww.com/sjkd/fulltext/2009/20020/epidemiology_of_nutritional_rickets_in_children.15.aspx

  In most developing countries, nutritional rickets is a major health problem. The aim of this study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical presentations, as well as to address the possible operating risk factors behind the disease. Nutritional rickets is still prevalent in Saudi Arabia with the primary etiology being vitamin D deficiency. The prolongation of exclusive breast-feeding until the age of one year without vitamin D supplement is an important factor leading to the development of rickets in the rapid growth period of infancy; in addition, none of our infants were exposed to direct sunlight. The most common physical signs of rickets were wide wrist (29%), rachitic rosary (28%), frontal bossing (16%), and wide anterior fontanel (15%). The need for vitamin D supplementation should not imply that human milk is nutritionally inadequate. Nutritional rickets is still prevalent in Saudi Arabia with the primary etiology in our cases being vitamin D deficiency. It is therefore recommended that every infant who is exclusively breastfed has a routine supplement of vitamin D in the range of 200 IU/day (alone or as part of multivitamin), started soon after birth until the time of weaning.

• #26 Pathogenesis and diagnostic criteria for rickets and osteomalacia — Proposal by an expert panel supported by Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]

  https://www.jstage.jst.go.jp/article/endocrj/62/8/62_EJ15-0289/_article

  Rickets and osteomalacia are diseases characterized by impaired mineralization of bone matrix. […] While these diseases can severely impair the quality of life of the affected patients, rickets and osteomalacia can be completely cured or at least respond to treatment when properly diagnosed and treated according to the specific causes. […] On the other hand, there are no standard criteria to diagnose rickets or osteomalacia nationally and internationally. […] Therefore, we summarize the definition and pathogenesis of rickets and osteomalacia, and propose the diagnostic criteria and a flowchart for the differential diagnosis of various causes for these diseases. […] We hope that these criteria and flowchart are clinically useful for the proper diagnosis and management of patients with these diseases.

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