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As such, evidence of rickets in the archeological record has been used as a proxy for vitamin D status in past individuals and populations. In the last decade, a clinical global consensus has emerged wherein it is recognized that dietary calcium deficiency also plays a role in the manifestation of rickets and classic skeletal deformities may not form if dietary calcium is normal even if vitamin D is deficient. This disease is now clinically called \u201cnutritional rickets\u201d to reflect the fact that rickets can take calcium deficiency\u2010predominant or vitamin D deficiency\u2010predominant forms. However, there are currently no paleopathological studies wherein dietary calcium deficiency is critically considered a primary etiology of the disease. We review here the interplay of calcium, vitamin D, and phosphorous in bone homeostasis, examine the role of dietary calcium in human health, and critically explore the clinical literature on calcium deficiency\u2010predominant rickets. Finally, we report a case of rickets from the late Formative Period (~2500\u20131500\u2009years ago) of the Atacama Desert and argue the disease in this infant is likely an example of calcium deficiency\u2010predominant rickets. We conclude that most archeological cases of rickets are the result of multiple micronutrient deficiencies that compound to manifest in macroscopic skeletal lesions. For clinicians, these factors are important for implementing best treatment practice, and for paleopathologists they are necessary for appropriate interpretation of health in past communities.<\/jats:p>","DOI":"10.1002\/ajhb.23819","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T17:16:53Z","timestamp":1666027013000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The role of dietary calcium in the etiology of childhood rickets in the past and the present"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5259-3819","authenticated-orcid":false,"given":"Melandri","family":"Vlok","sequence":"first","affiliation":[{"name":"Sydney Southeast Asia Centre The University of Sydney  Camperdown Australia"},{"name":"Department of Anatomy, School of Biomedical Sciences University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Marie E.","family":"Snoddy","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Biomedical Sciences University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Biomedical Sciences University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, Otago Medical School University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivien G.","family":"Standen","sequence":"additional","affiliation":[{"name":"Departamento de Antropolog\u00eda Universidad de Tarapac\u00e1  Arica Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo T.","family":"Arriaza","sequence":"additional","affiliation":[{"name":"Instituto de Alta Investigaci\u00f3n Universidad de Tarapac\u00e1  Arica Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780429355912-10"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-809965-0.00054-9"},{"issue":"1","key":"e_1_2_11_4_1","first-page":"728","article-title":"Bony manifestation of rickets in a sunny city\u2010a case report from Yazd, Iran","volume":"6","author":"Afrand M.","year":"2014","journal-title":"Electronic Physician"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2020.115357"},{"issue":"2","key":"e_1_2_11_6_1","first-page":"253","article-title":"Pulmonary disease in a sample of mummies from the Az\u201075 cemetery in northern Chile's Azapa Valley","volume":"34","author":"Aufderheide A. 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