GROWTH AND DEVELOPMENT: Edited by Lynne L. LevitskyAn Update on Vitamin D Deficiency in the twenty-first century: nature and nurtureStoffers, Ashley J.; Weber, David R.; Levine, Michael A. Author Information The Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA Correspondence to Michael A. Levine, The Children's Hospital of Philadelphia, 3401 Civic Centre Blvd, Philadelphia, PA 19104, USA. Tel: +1 215 590 3174; e-mail: [email protected] Current Opinion in Endocrinology & Diabetes and Obesity: February 2022 - Volume 29 - Issue 1 - p 36-43 doi: 10.1097/MED.0000000000000691 Buy Metrics Abstract Purpose of review Here, we review the most up-to-date understanding of the pathogenesis, prevention and treatment of vitamin D deficient rickets in children. This will include recent advances in the genetic determinants of abnormal vitamin D metabolism, with the intention of aiding clinicians with establishing the diagnosis and implementing treatment plans for children presenting with vitamin D deficiency rickets. Recent findings Vitamin D deficiency rickets is a frequently encountered, but entirely preventable, disorder of bone mineral metabolism. Risk factors for developing vitamin D deficiency rickets include inadequate exposure to sunlight, exclusive breast feeding without vitamin D supplementation and inadequate intake of vitamin D, calcium or phosphorus. Other factors that may influence the development of vitamin D deficiency and/or rickets include genetic alterations or medications that alter vitamin D metabolism. Summary Vitamin D levels in individuals are influenced by environmental factors, as well as genetic factors. A thorough understanding of these factors is critical for the evaluation and treatment of a child presenting with rickets. There remains a great need for additional research to determine ideal vitamin D status across diverse populations, and to better understand how vitamin D status affects overall health. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.