佝偻病

维生素 D 缺乏性佝偻病的患病率高峰通常在 6 至 18 月龄，而另一较小程度的高峰出现在青春期。[1]Pettifor JM. Rickets and vitamin D deficiency in children and adolescents. Endocrinol Metab Clin North Am. 2005 Sep;34(3):537-53, vii.http://www.ncbi.nlm.nih.gov/pubmed/16085158?tool=bestpractice.com

佝偻病只会在骺板尚未闭合时发生。[9]Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006 Aug;116(8):2062-72.https://www.jci.org/articles/view/JCI29449http://www.ncbi.nlm.nih.gov/pubmed/16886050?tool=bestpractice.com

生活在纬度高于北纬或南纬 40º 的地区或有遮盖皮肤文化习俗的地区，会降低皮肤对胆骨化醇的合成。[8]Weisberg P, Scanlon KS, Li R, et al. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr. 2004 Dec;80(suppl 6):1697-705S.https://academic.oup.com/ajcn/article/80/6/1697S/4690514http://www.ncbi.nlm.nih.gov/pubmed/15585790?tool=bestpractice.com[11]Bandeira F, Griz L, Dreyer P, et al. Vitamin D deficiency: a global perspective. Arq Bras Endocrinol Metabol. 2006 Aug;50(4):640-6.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302006000400009&lng=en&nrm=iso&tlng=enhttp://www.ncbi.nlm.nih.gov/pubmed/17117289?tool=bestpractice.com 防晒霜使用的增加也可能是原因之一。[10]Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther. 2010 Jan-Feb;23(1):48-60.http://www.ncbi.nlm.nih.gov/pubmed/20136908?tool=bestpractice.com

母乳缺乏维生素 D。不进行营养补充，则可能患佝偻病。[3]Wharton B, Bishop N. Rickets. Lancet. 2003 Oct 25;362(9393):1389-400.http://www.ncbi.nlm.nih.gov/pubmed/14585642?tool=bestpractice.com

钙摄取不充足可导致骨矿化作用不足。母乳中钙含量有限，但牛奶可提供较丰富的钙。[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26.https://www.aafp.org/afp/2006/0815/p619.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com 没有喝牛奶传统的人群中，钙摄取通常＜300 mg/天。钙和其他矿物质的净吸收受其他食物成分（例如，大部分谷类食物中含的植酸）的影响。[3]Wharton B, Bishop N. Rickets. Lancet. 2003 Oct 25;362(9393):1389-400.http://www.ncbi.nlm.nih.gov/pubmed/14585642?tool=bestpractice.com

磷酸盐摄取不充足可导致骨矿化作用不足。大部分食物中富含磷酸盐，但对于快速生长的低出生体重婴儿可能不够。磷酸盐会因抗酸药而沉淀于胃中。[3]Wharton B, Bishop N. Rickets. Lancet. 2003 Oct 25;362(9393):1389-400.http://www.ncbi.nlm.nih.gov/pubmed/14585642?tool=bestpractice.com

身材矮小、骨骼异常、牙齿发育不良、脱发及父母的类似病史预示遗传性佝偻病。[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26.https://www.aafp.org/afp/2006/0815/p619.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com

含有铝的抗酸剂会将磷酸盐沉淀于胃中。[3]Wharton B, Bishop N. Rickets. Lancet. 2003 Oct 25;362(9393):1389-400.http://www.ncbi.nlm.nih.gov/pubmed/14585642?tool=bestpractice.com[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26.https://www.aafp.org/afp/2006/0815/p619.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com 可导致钙和磷酸盐缺乏的其他药物包括袢利尿剂和皮质类固醇，而苯妥英会导致靶器官对骨化三醇产生抵抗。[4]Nield LS, Mahajan P, Joshi A, et al. Rickets: not a disease of the past. Am Fam Physician. 2006 Aug 15;74(4):619-26.https://www.aafp.org/afp/2006/0815/p619.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16939184?tool=bestpractice.com

皮肤色素增加可能需要增加日晒，从而使得 7-脱氢胆固醇充分转化为胆骨化醇。[3]Wharton B, Bishop N. Rickets. Lancet. 2003 Oct 25;362(9393):1389-400.http://www.ncbi.nlm.nih.gov/pubmed/14585642?tool=bestpractice.com