Rickets in the Tropics: A Case Report From Manila City

Dizon, P O; Stransky, E

doi:10.1093/oxfordjournals.tropej.a057374

Cited by 2 publications

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“…By the mid‐20th century, clinical researchers noticed that rickets occurred in Africa and Asia in areas of sufficient atmospheric UV rays (Jelliffe, 1951; Lovett‐Campbell, 1952; Stransky & Dizon, 1955; Williams, 1946). Admittedly, the clinical research of this time is difficult to couple to pre‐industrial archeological cases of rickets in tropical and desert zones as rickets was clinically observed in poor communities who lived in dark cubicle houses in urban slums following rapid industrialization (Stransky & Dizon, 1955; Williams, 1946). Additionally, these earlier works are severely biased against the affected groups, typical of a time when eugenics still influenced anthropological and biological thought.…”

Section: Introductionmentioning

confidence: 99%

The role of dietary calcium in the etiology of childhood rickets in the past and the present

Vlok

Snoddy

Niranjan

et al. 2022

American J Hum Biol

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For more than two centuries, lack of sunlight has been understood to cause vitamin D deficiency and documented as a primary cause of rickets. As such, evidence of rickets in the archeological record has been used as a proxy for vitamin D status in past individuals and populations. In the last decade, a clinical global consensus has emerged wherein it is recognized that dietary calcium deficiency also plays a role in the manifestation of rickets and classic skeletal deformities may not form if dietary calcium is normal even if vitamin D is deficient. This disease is now clinically called "nutritional rickets" to reflect the fact that rickets can take calcium deficiency-predominant or vitamin D deficiency-predominant forms. However, there are currently no paleopathological studies wherein dietary calcium deficiency is critically considered a primary etiology of the disease. We review here the interplay of calcium, vitamin D, and phosphorous in bone homeostasis, examine the role of dietary calcium in human health, and critically explore the clinical literature on calcium deficiency-predominant rickets. Finally, we report a case of rickets from the late Formative Period ($2500-1500 years ago) of the Atacama Desert and argue the disease in this infant is likely an example of calcium deficiencypredominant rickets. We conclude that most archeological cases of rickets are the result of multiple micronutrient deficiencies that compound to manifest in macroscopic skeletal lesions. For clinicians, these factors are important for implementing best treatment practice, and for paleopathologists they are necessary for appropriate interpretation of health in past communities.

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