Rickets: Global Battle Intensifies with New Treatments and Public Health Strategies

Rickets, a debilitating bone disorder predominantly affecting children, continues to be a significant public health concern worldwide, particularly in regions with limited access to nutritious food and adequate sunlight. However, a multi-pronged offensive is underway, combining groundbreaking genetic therapies, enhanced nutritional strategies, and intensified public health campaigns to combat this preventable disease.

The Silent Epidemic: Nutritional Rickets Still Prevalent

While largely eradicated in many developed nations through food fortification, nutritional rickets, primarily caused by severe vitamin D and/or calcium deficiency, remains a "silent epidemic" in various parts of the world. Recent reports from India, for instance, highlight that one in five Indians suffers from extremely low levels of vitamin D, with children disproportionately affected by rickets, leading to soft and weak bones and skeletal deformities. Factors like urban lifestyles, high-rise buildings blocking sunlight, air pollution, lack of fortified foods, and cultural practices limiting sun exposure contribute to this persistent deficiency.

Understanding the Causes:

• Vitamin D Deficiency: The most common cause, hindering the body's ability to absorb calcium and phosphate from food.
• Calcium/Phosphate Deficiency: Insufficient dietary intake of these essential minerals.
• Genetic Disorders: Rare inherited forms like Hypophosphatemic Rickets affect the body's ability to regulate phosphate.
• Other Medical Conditions: Kidney problems, celiac disease, inflammatory bowel disease, and certain medications can impair vitamin D absorption or metabolism.

Breakthroughs in Treatment and Management:

The global market for Rickets Treatment is projected to reach US$1.2 billion by 2030, reflecting a surge in advanced diagnostic tools and innovative therapies:

• Targeted Therapies for Genetic Rickets: Decades of research have culminated in significant advancements for hereditary forms of rickets. For X-linked hypophosphatemia (XLH), the most common inherited type, the FDA-approved drug burosumab (Crysvita®), a monoclonal antibody targeting FGF23, has revolutionized treatment. It normalizes blood phosphate levels, significantly improving rickets and bone deformities in children and promoting bone healing in adults. Research continues on ultra-rare variants like Autosomal Dominant Hypophosphatemic Rickets (ADHR), with promising clinical trials exploring oral iron therapy to restore phosphate conservation.
• Improved Nutritional Supplementation: The development of more effective and bioavailable vitamin D and calcium supplements, available in various formulations (oral tablets, liquids, injections), is enhancing the management of nutritional rickets. High-dose vitamin D supplements are particularly effective for severe cases.
• Advanced Diagnostics: Enhanced imaging techniques (X-rays, MRI, bone density scans) allow for earlier and more accurate detection of bone deformities, enabling timely intervention.
• Optimizing Surgical Outcomes: For severe skeletal deformities, orthopedic surgery like hemiepiphysiodesis (guided growth surgery) plays a critical role. Recent studies emphasize that metabolic control after surgery is crucial for successful correction of leg deformities in children with hypophosphatemic rickets, highlighting the importance of sustained medical management post-operatively.

Prevention Efforts Scale Up:

Prevention remains the most effective strategy against nutritional rickets. Global initiatives and recommendations focus on:

• Universal Vitamin D Supplementation: Guidelines advocate for daily vitamin D supplementation (e.g., 400 IU/day for infants) for all infants from birth, especially those exclusively breastfed, as breast milk contains insufficient vitamin D.
• Food Fortification Programs: Mandatory fortification of staple foods like milk, cereals, and cooking oils with vitamin D and calcium is a proven, cost-effective public health strategy that has successfully reduced rickets incidence in many countries.
• Public Awareness Campaigns: Mobile health technologies and community-based programs are increasing awareness about the importance of sunlight exposure (safe exposure for 10-15 minutes near midday), vitamin D-rich foods (fatty fish, egg yolks), and the benefits of supplements.
• Maternal Health: Ensuring adequate vitamin D intake for pregnant women is crucial to prevent congenital rickets in newborns.

As medical science progresses and public health bodies intensify their efforts, there is renewed hope for reducing the global burden of rickets, ensuring healthier bone development and improved quality of life for children worldwide.