Nutritional rickets in Turkey.

Nutritional rickets (NR) remains the most common form of developmental bone disease, in spite of the efforts of clinicians and health care providers to reduce the incidence of the disease in Turkey. Today, it is well known that the etiology of NR exists along a spectrum ranging from isolated vitamin D deficiency to isolated calcium deficiency. In Turkey, almost all NR results from vita-min D deficiency that may have temporary but profound effects on short- and long-term skeletal development. Recent evidence suggests that vitamin D deficiency during infancy may predispose a patient to diseases such as diabetes mellitus, cancer, multiple sclerosis, etc. The factors responsible for the high prevalence of vitamin D deficiency in developing countries and its resurgence in developed countries include the following: limited sunshine exposure as individuals spend more time indoors watching television and working on computers or intentional sunshine avoidance for skin cancer prevention. Traditional clothing (covered dress) further limits the exposure to sunshine and thus decreases the endogenous synthesis of vitamin D. In Turkey, maternal vitamin D deficiency and breast feeding without supplementation are the most prominent reasons. The diagnosis of NR is established with a thorough history and physical examination and confirmed by laboratory evaluation. In conclusion, recent literature has drawn attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l), the serum concentration that is needed to optimize absorption of dietary calcium, suppress excess secretion of parathyroid hormone, and reduce fracture risk as well as prevent long-term negative effects.