Global consensus recommendations on prevention and management of nutritional rickets

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

Research output: Contribution to journalReview articlepeer-review

95 Citations (Scopus)


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 describes 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
Pages (from-to)83-106
Number of pages24
JournalHormone Research in Paediatrics
Issue number2
Publication statusPublished or Issued - 2016


  • Calcium
  • Consensus recommendations
  • Nutrition
  • Rickets
  • Vitamin D

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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