Epidemiology

In the US, Europe, and East Asia, more than 40% of the adult population are vitamin D deficient, this being the most prominent cause of osteomalacia.​​[8][9]​​​ The incidence of nutritional rickets and osteomalacia is rising globally, including high-income countries where hospitalization for rickets has increased in recent decades.[10][11]​​ The prevalence of osteomalacia at postmortem in European adults is up to 25%.[12]

In some developing countries, such as Tibet and Mongolia, vitamin D deficiency leading to clinical rickets is reported in 60% of infants.[13] In the Middle East, a high prevalence of rickets and osteomalacia has been described in Muslim women and their infants, perhaps due to increased clothing coverage of the skin.[14] Fortification of foods with vitamin D and the use of vitamin supplements has greatly reduced the incidence of osteomalacia in the Western world.[15] Despite this, vitamin D-related osteomalacia still occurs with the consumption of unfortified foods, especially in the setting of limited sunlight exposure.[16]

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