Global consensus recommendations on prevention and management of nutritional rickets

Magda Aguiar, Navoda Atapattu, Vijayalakshmi Bhatia, Christian Braegger, Gary Butler, Hamilton Cassinelli, Linda A. DIMeglio, Emma Frew, Junfen Fu, Gail Goldberg, Wolfgang Högler, Elina Hyppönen, Hafsatu Wasagu Idris, Rajesh Khadgawat, Mairead Kiely, Jane Maddock, Outi Mäkitie, Toshimi Michigami, M. Zulf Mughal, Craig F. MunnsAbiola Oduwole, Keiichi Ozono, John M. Pettifor, Pawel Pludowski, Lorna Ramos-Abad, Lars Sävendahl, Anju Seth, Nick Shaw, Bonny L. Specker, Tom D. Thacher, Dov Tiosano, Ted Tulchinsky, Leanne Ward

Research output: Contribution to journalArticle

312 Scopus citations


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 evidencebased 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 childrenwasconducted. Evidence-basedrecommendationsweredevelopedusing 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.

Original languageEnglish (US)
Pages (from-to)394-415
Number of pages22
JournalJournal of Clinical Endocrinology and Metabolism
Issue number2
StatePublished - Feb 2016

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Aguiar, M., Atapattu, N., Bhatia, V., Braegger, C., Butler, G., Cassinelli, H., DIMeglio, L. A., Frew, E., Fu, J., Goldberg, G., Högler, W., Hyppönen, E., Idris, H. W., Khadgawat, R., Kiely, M., Maddock, J., Mäkitie, O., Michigami, T., Mughal, M. Z., ... Ward, L. (2016). Global consensus recommendations on prevention and management of nutritional rickets. Journal of Clinical Endocrinology and Metabolism, 101(2), 394-415.