Abstract
Nutritional or classical rickets (here labeled as “rickets”) is a worldwide disease involving mostly infants and young children having inadequate sunlight exposure, often associated with a low dietary intake of Vitamin D. Rickets targets all layers of society independently of economic status with historical information spanning more than two millennia. Vitamin D is critical for the absorption of calcium and prevention of rickets in children as well as osteomalacia in adults. The initial and misleading paradigm of the 19th and 20th centuries that rickets may have been the consequence of infection has been, indeed, reversed following the identification of the Vitamin D molecule’s important role in the function of the immune system. Although traditionally considered limited to osteopathology, Vitamin D deficiency is now known to be linked to infection, inflammation, and carcinogenesis. In this review, we consider the key historical (Whistler, pre-Whistler and post-Whistler descriptors) and social facts around rickets; highlight the osteo-pathological features of rickets and the pathology of the upper and lower respiratory tract, stressing the fact that lungs remain the main secondary organ affected by Vitamin D deficiency; and emphasize the public health role in identifying the cases of child neglect or abuse based on the evaluation of the costochondral region.
Highlights
Rickets is no longer considered a disease of the past or a disease that is limited to low-income countries
Vitamin D is a fat-soluble vitamin, which has a unique metabolic pathway in that it is produced in the skin during sunlight exposure, unlike vitamins A, E, and K that are strictly absorbed from the diet
We report on the history of the “English Disease”, highlight the osteopathological features of rickets as well as the pathology of the respiratory tract, and discuss the leading role of public health in identifying cases of child neglect or abuse, and the impact of socio-ideological debates
Summary
Rickets is no longer considered a disease of the past or a disease that is limited to low-income countries. The number of publications and diseases that may be associated with Vitamin D deficiency is rapidly increasing, and more and more clinical laboratories are being asked to measure 25-hydroxy(OH)-Vitamin D (25[OH]D) levels [1,2,3,4,5] by both physicians and legal courts [6,7] Large population surveys, such as the Nutrition Examination Survey and National Health, have suggested that many children and pregnant women may be affected by Vitamin D deficiency at some point during their lifetime [8,9,10,11,12,13]. Latitude > 40 degrees (North or South), “long winters”, air polluted geographical areas, and “perennial clouding” geographical areas
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