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Advances in Pediatrics

Shedding Light on Hypovitaminosis D and Rickets

      In 1966, in an article entitled The Disappearance of Rickets, Harrison reported that vitamin D deficiency rickets had become so rare as to be a “medical curiosity” in children [
      • Harrison H.E.
      The disappearance of rickets.
      ]. A number of reports suggest, however, that the recent worldwide prevalence of the disease is increasing [
      • Calikoglu A.S.
      • Davenport M.S.
      Prophylactic vitamin D supplementation.
      ]. In the United States, over 100 cases of rickets have been reported in the last 10 years. These occur primarily in dark-skinned, breast-feeding infants and toddlers with little sun exposure whose intake of dietary vitamin D is low. Not infrequently, they are exclusively breast fed by a mother who receives insufficient dietary vitamin D from milk, meat, eggs, or fish, or who ingests an unsupplemented vegetarian diet [
      • Bhowmick S.K.
      • Johnson K.R.
      • Rettig K.R.
      Rickets caused by vitamin D deficiency in breast-fed infants in the southern United States.
      ,
      • Pugliese M.T.
      • Blumberg D.L.
      • Hludzinski J.
      • et al.
      Nutritional rickets in suburbia.
      ]. Hypovitaminosis D is also common in older children, adults, and the elderly. Vitamin D deficiency may also result from malabsorptive conditions, such as celiac disease, biliary obstruction, gastric resection, or pancreatic insufficiency, as well as from accelerated metabolism by anticonvulsants, such as phenytoin, that degrade vitamin D to rapidly excreted water-soluble forms.
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