The evolution of rickets through the ages

Rickets is an ancient disease and for centuries different conceptions were adopted regarding its type, causes, and treatment options. The discovery of vitamin D transformed the landscape of rickets and was followed by the discovery of several new therapies that improved treatment out-comes. In parallel, the development of rickets detection technology and new workup for vitamin D improved rickets management. Remarkably a century later, vitamin D remains the cornerstone of rickets treatment. In this review, we aim to highlight the lessons learned from the limitations of vitamin D knowledge over the past century. Finally, progress continues in the field of bu-rosumab, a human monoclonal antibody to FGF23, which is approved for the treatment of X-linked hypophosphatemia among children 1 year and older, perhaps the ultimate frontier in rickets management.