Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2016 Jan 9

PMID 26745253

Citations 382

Authors

Craig F Munns

Nick Shaw

Mairead Kiely

Bonny L Specker

Tom D Thacher

Keiichi Ozono

Toshimi Michigami

Dov Tiosano

M Zulf Mughal

Outi Makitie

Lorna Ramos-Abad

Leanne Ward

Linda A DiMeglio

Navoda Atapattu

Hamilton Cassinelli

Christian Braegger

John M Pettifor

Anju Seth

Hafsatu Wasagu Idris

Vijayalakshmi Bhatia

Junfen Fu

Gail Goldberg

Lars Savendahl

Rajesh Khadgawat

Pawel Pludowski

Jane Maddock

Elina Hypponen

Abiola Oduwole

Emma Frew

Magda Aguiar

Ted Tulchinsky

Gary Butler

Wolfgang Hogler

Affiliations

Soon will be listed here.

Abstract

Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication.

Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence.

Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus.

Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts.

Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

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