E-Mail karger@karger.com Consensus Statement Horm Res Paediatr 2016;85:83–106 DOI: 10.1159/000443136 Global Consensus Recommendations on Prevention and Management of Nutritional Rickets Craig F. Munns Nick Shaw Mairead Kiely Bonny L. Specker Tom D. Thacher Keiichi Ozono Toshimi Michigami Dov Tiosano M. Zulf Mughal Outi Mäkitie Lorna Ramos-Abad Leanne Ward Linda A. DiMeglio Navoda Atapattu Hamilton Cassinelli Christian Braegger John M. Pettifor Anju Seth Hafsatu Wasagu Idris Vijayalakshmi Bhatia Junfen Fu Gail Goldberg Lars Sävendahl Rajesh Khadgawat Pawel Pludowski Jane Maddock Elina Hyppönen Abiola Oduwole Emma Frew Magda Aguiar Ted Tulchinsky Gary Butler Wolfgang Högler nology, 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, par- ticipated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic crite- ria and describes the clinical management of rickets and os- teomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations in- cluding food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficien- cies are preventable global public health problems in in- fants, children, and adolescents. Implementation of interna- tional rickets prevention programs, including supplementa- tion and food fortification, is urgently required. © 2016 S. Karger AG, Basel and The Endocrine Society Key Words Rickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and calcium deficiencies are com- mon worldwide, causing nutritional rickets and osteomala- cia, which have a major impact on health, growth, and devel- opment of infants, children, and adolescents; the conse- quences 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, di- agnosis, and management of nutritional rickets and to pro- vide policy makers with a framework to work toward its erad- ication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutri- tional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evalua- tion (GRADE) system that describes the strength of the rec- ommendation and the quality of supporting evidence. Pro- cess: Thirty-three nominated experts in pediatric endocri- Received: April 24, 2015 Accepted: September 17, 2015 Published online: January 8, 2016 HORMONE RESEARCH IN PÆDIATRICS Dr. Wolfgang Högler Department of Endocrinology and Diabetes Birmingham Children’s Hospital, Steelhouse Lane Birmingham B4 6NH (UK) wolfgang.hogler  @  bch.nhs.uk © 2016 S. Karger AG, Basel and The Endocrine Society 1663–2818/16/0852–0083$39.50/0 www.karger.com/hrp See the Appendix for author affiliations. This article is simultaneously published in The Journal of Clinical Endo- crinology and Metabolism (DOI: 10.1210/jc.2015-2175).