Abstract
Since first described almost a century ago, vitamin D preparations have been successfully used as a public health intervention to prevent nutritional rickets. In this manuscript, we document the periods in history when nutritional rickets was described, examine early efforts to understand its etiology and the steps taken to treat and prevent it. We will also highlight that despite the wealth of historical data and multiple preventative strategies, nutritional rickets remains a significant public health disorder. Nutritional rickets has both skeletal and extraskeletal manifestations. While the skeletal manifestations are the most recognized features, it is the extraskeletal complications, hypocalcaemic seizure and cardiomyopathy that are the most devastating features and result in reported fatalities. Reviewing this history provides an opportunity to further promote recent global consensus recommendations for the prevention and management of nutritional rickets, as well as gain a greater understanding of the well-known public health measures that can be used to manage this entirely preventable disease.
Highlights
An adequate serum concentration of Vitamin D is required for optimal absorption of calcium from the gastrointestinal tract
In this review we provide a historical perspective on nutritional rickets
The number of reported paleopathological cases of rickets increases significantly from the seventeenth to nineteenth centuries, coinciding with the industrial revolution. This suggests that overcrowding, an increase in specialized indoor occupations, and poor air quality, and possibly decreased calcium in the diet [via an increasing dietary role of bread at the expense of diary [15]] all contributed to vitamin D deficiency and nutritional rickets as a consequence of decreased calcium and ultraviolet B (UVB) exposure [16]
Summary
Since first described almost a century ago, vitamin D preparations have been successfully used as a public health intervention to prevent nutritional rickets In this manuscript, we document the periods in history when nutritional rickets was described, examine early efforts to understand its etiology and the steps taken to treat and prevent it. We will highlight that despite the wealth of historical data and multiple preventative strategies, nutritional rickets remains a significant public health disorder Nutritional rickets has both skeletal and extraskeletal manifestations. While the skeletal manifestations are the most recognized features, it is the extraskeletal complications, hypocalcaemic seizure and cardiomyopathy that are the most devastating features and result in reported fatalities Reviewing this history provides an opportunity to further promote recent global consensus recommendations for the prevention and management of nutritional rickets, as well as gain a greater understanding of the well-known public health measures that can be used to manage this entirely preventable disease
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