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From the Chairman's Desk
From the Chairman's Desk is a new series of review articles written by chairmen of pediatrics, which not only provides a scholarly update of medical information by world experts, but allows the reader to become better acquainted with individuals who are considered the "pediatrician's pediatrician."
Author's Comment
When the editor, Russell Steele, asked me to contribute to this section of the journal, I proposed that it would be appropriate to discuss a public health issue that has reemerged over the past decade. Nutritional rickets is diagnosed in locations where sunshine is ample and dietary calcium and phosphate requirements are readily met.' Nonetheless, rickets has appeared for the third time in the past 100 years. The lesson to be learned from this third wave of the appearance of nutritional rickets is that disease will recur if the factors that keep it at bay are ignored. The clear message here is that "one can develop nutritional vitamin D-deficient rickets if the dietary and cutaneous sources of vitamin D are forgotten. . ."
Nestled among the remarkable biomedical advances occurring during 20th century is the appreciation that a common childhood disorder of the early century, rickets, could be prevented by vitamin D supplements and completely cured with these vitamin supplementations of foods.2 This monumental achievement of the 1920s and 1930s has relegated nutritional rickets to only a few paragraphs in standard textbooks and resulted in a greater emphasis on the hereditary forms of rickets, albeit uncommon; and the exploitation of these hereditary disorders to provide insight into the metabolism, receptor binding, and biologic roles of vitamin D.3
Whenever bone is undermineralized, it becomes soft and less capable of weight bearing. This condition of bone is called osteomalacia. Its characteristic features include marked increases in the surface area of the bone trabeculum that is not mineralized with hydroxyapatite, widening of the bone trabeculum, and a high rate of bone turnover.4 When osteomalacia occurs in the growing child, a prominent lesion is evident at the growth plate and is called rickets. In this condition, the degenerating chondrocyte does not mineralize on the metaphyseal side of the growth plate with a subsequent failure of mineralization of the long bones, evident at the wrist, knees, and...