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A brief history of rickets

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Abstract

The review provides a historical perspective on the convergence of our understanding of the physiology and pathophysiology of bone, calcium, phosphorus, vitamin D, parathyroid hormone, and FGF-23 their impact on rickets.

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Authors and Affiliations

  1. University of Minnesota, Minneapolis, MN, USA

    Aaron Friedman

  2. University of Wisconsin, Madison, WI, USA

    Aaron Friedman

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  1. Aaron Friedman
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Correspondence to Aaron Friedman.

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Additional information

Answers: 1. c; 2. d; 3. b; 4. a; 5. d

Summary points

1. Rickets, a condition that results in soft and deformed bones in children, was a common condition, especially in the Northern hemisphere, and exacerbated by the industrial revolution and its resultant reduction in sunlight.

2. Progress in the treatment and prevention of rickets moved forward in the late 19th and 20th century with the findings that: (1) cod liver oil contained a substance that helped heal bones, (2) sunlight or UV light also helped heal bones, (3) the active substance was vitamin D. Irradiation of food, but especially milk, made the important precursor of the active form of vitamin D widely available in a form more palatable than cod liver oil.

3. In the 20th century, the interplay of bone, parathyroid hormone, vitamin D, calcium, and phosphorus vastly improved our understanding of normal bone health and greatly improved our understanding of bone pathology in rickets.

4. With a better understanding of the prevention and treatment of nutritional rickets, advancements in the understanding of the pathophysiology of rarer forms of rickets (chronic kidney disease, hypophosphatemic rickets) and tools to treat them, took place in the latter half of the 20th century and into the 21st century. These have included the synthesis of 1,25 dihydroxyvitamin D and the FGF-23 monoclonal antibody, burosomab.

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Friedman, A. A brief history of rickets. Pediatr Nephrol 35, 1835–1841 (2020). https://doi.org/10.1007/s00467-019-04366-9

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