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This results in a reduction in DNA synthesis and particularly affects rapidly dividing cells. Methotrexate is prescribed for oral administration once a week and it is extremely important the patients understand this. Bone marrow depression and hepatotoxicity are the main complications. Blood counts should be checked every two to three months and liver biopsies taken every one to two years to monitor treatment.

Osteomalacia in childhood is known as ricketts and leads to soft bones with characteristic deformities. In adults there is generalized reduction in mineralization of bone matrix and symptoms of bone pain and tenderness. Nutritional rickets results from inadequate exposure to sunlight or deficiency of vitamin D. Metabolic rickets and osteomalacia result from abnormality in synthesis of or response to calcitriol, the active form of vitamin D.

In order for tumours to grow they need to develop a blood supply. Drugs are being developed that inhibit angiogenesis, which is the growth of new blood vessels. A monoclonal antibody that inhibits vascular endothelial growth factor already exists for use in metastatic colorectal cancer.

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