Does a Low Intake of Calcium Cause or Promote the Development of Rickets?.

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Abstract
It is widely believed that a low intake of calcium can cause or predispose to the development of rickets. To determine accurately the responsibility borne by a low level of calcium intake in the etiology of rickets is almost impossible, due to (1) the unfeasibility of carrying out a carefully controlled study, (2) uncertainties in the diagnosis of the disease, and (3) lack of a reliable method of assessing the calcium status of patients. If calcium deficiency be implicated, calcium salts should evoke some ameliorating response. Such an effect has not been satisfactorily demonstrated. Wartime experience has indicated that when calcium intake is reduced, even drastically, no increase in the incidence of rickets occurs. In tropical and semitropical countries where a low calcium intake is almost invariable, rickets is uncommon when advantage is taken of the available radiation. In countries less favored in the latter respect, no studies on rickets appear to implicate, even indirectly, the level of calcium intake as an influencing factor. While there seems to be no evidence that a low calcium intake promotes, still less causes, rickets, the possibility that level of intake has a modicum of etiological significance cannot be completely excluded. It would seem wholly unwarrantable, however, to list prophylaxis against rickets as a reason for insisting on the high intakes of calcium at present recommended.

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