title: Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.
abstract: 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.
  
  
  METHODS
  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 describe the strength of the recommendation and the quality of supporting evidence.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Craig F
authors.initials: CF
authors.lastname: Munns
authors.forename: Nick
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authors.lastname: Shaw
authors.forename: Mairead
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authors.lastname: Kiely
authors.forename: Bonny L
authors.initials: BL
authors.lastname: Specker
authors.forename: Tom D
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authors.lastname: Thacher
authors.forename: Keiichi
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authors.lastname: Ozono
authors.forename: Toshimi
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authors.lastname: Michigami
authors.forename: Dov
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authors.lastname: Tiosano
authors.forename: M Zulf
authors.initials: MZ
authors.lastname: Mughal
authors.forename: Outi
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authors.lastname: Mäkitie
authors.forename: Lorna
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authors.lastname: Ramos-Abad
authors.forename: Leanne
authors.initials: L
authors.lastname: Ward
authors.forename: Linda A
authors.initials: LA
authors.lastname: DiMeglio
authors.forename: Navoda
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authors.lastname: Atapattu
authors.forename: Hamilton
authors.initials: H
authors.lastname: Cassinelli
authors.forename: Christian
authors.initials: C
authors.lastname: Braegger
authors.forename: John M
authors.initials: JM
authors.lastname: Pettifor
authors.forename: Anju
authors.initials: A
authors.lastname: Seth
authors.forename: Hafsatu Wasagu
authors.initials: HW
authors.lastname: Idris
authors.forename: Vijayalakshmi
authors.initials: V
authors.lastname: Bhatia
authors.forename: Junfen
authors.initials: J
authors.lastname: Fu
authors.forename: Gail
authors.initials: G
authors.lastname: Goldberg
authors.forename: Lars
authors.initials: L
authors.lastname: Sävendahl
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khadgawat
authors.forename: Pawel
authors.initials: P
authors.lastname: Pludowski
authors.forename: Jane
authors.initials: J
authors.lastname: Maddock
authors.forename: Elina
authors.initials: E
authors.lastname: Hyppönen
authors.forename: Abiola
authors.initials: A
authors.lastname: Oduwole
authors.forename: Emma
authors.initials: E
authors.lastname: Frew
authors.forename: Magda
authors.initials: M
authors.lastname: Aguiar
authors.forename: Ted
authors.initials: T
authors.lastname: Tulchinsky
authors.forename: Gary
authors.initials: G
authors.lastname: Butler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Högler
mesh_terms: D002118:Calcium / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D006291:Health Policy; D006801:Humans; D007223:Infant; D009035:Mothers; D010018:Osteomalacia / Q000175:diagnosis / Q000628:therapy; D064167:Recommended Dietary Allowances; D012279:Rickets / Q000517:prevention & control* / Q000628:therapy; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000628:therapy; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002118:Calcium