Surgery for Pediatric Fracures 55 X more likely if < 12 ng of Vitamin D
Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures
Journal of Pediatric Orthopaedics 37(1):p 23-29, January 2017. | DOI: 10.1097/BPO.0000000000000587 Paywall
Minkowitz, Barbara MD; Cerame, Barbara MD†; Poletick, Eileen RN, DNP; Nguyen, Joseph T. MPH‡; Formoso, Nicole D.; Luxenberg, Sherri L. BA; Lee, Ben H. MD, MPH, MSCR†; Lane, Joseph M. MD‡
Background: There is growing concern over the relationship between the severity of pediatric fractures and low vitamin D [25-hydroxyvitaminD (25(OH)D)] status.
Objective: Compare 25(OH)D levels and lifestyle of children with fractures to nonfracture controls to determine if 25(OH)D levels are associated with fractures and if there is a 25(OH)D fragility fracture threshold.
Methods: Pediatric fracture and nonfracture controls were included. Bone health survey and medical record data were analyzed. Fractures were categorized using the Abbreviated Injury Scale (AIS). AIS 3 fractures were identified as fractures that required surgical intervention. Univariate and multivariable ordinal regression analyses were performed to identify potential risk factors for increased fracture severity.
Results: A total of 369 fracture patients and 662 nonfracture controls aged 18 years and younger were included. Both groups’ 25(OH)D levels were comparable. 25(OH)D was 27.5±8.9 in the fracture group compared with 27.4±9.1 ng/mL in nonfracture controls (P=0.914). AIS 3 fractures had lower 25(OH)D levels (24.6±9.3 ng/mL) versus AIS 1 and 2 (30.0±10.8 and 28.3±8.4, respectively, P=0.001). Univariate correlations for AIS severity were found with age (P=0.015) and outdoor playtime (P=0.042).
Adjusted odds ratios for
- 25(OH)D levels <12 ng/mL was 55.4 (P=0.037),
- 25(OH)D between 12 and 20 ng/mL was 6.7 (P=0.039),
- 25(OH)D between 20 and 30 ng/mL was 2.8 (P=0.208), and
- 25(OH)D between 30 and 40 was 1.7 (P=0.518).
Clinical Relevance: Occurrence of a pediatric fracture was not associated with 25(OH)D levels in our study. However, children with lower vitamin D levels were found to be at higher risk for more severe fractures. Early evidence suggests that the target serum level for 25(OH)D should be at least 40 ng/mL in patients less than 18 years of age as the relative risk of more severe fractures increased as 25(OH)D levels decreased <40 ng/mL.
Level of Evidence: Level III.
Related in Vitamin D Life
- Vitamin D deficiency in children: 9%, but up to 75% in children with fractures
- Hip fractures are predicted by 10 factors – low Vitamin D was the biggest risk
- Leg fractures in children requiring surgery healed months faster if high vitamin D
- Forearm fractures in children having low Vitamin D had 3.8 X higher risk of surgery
- Bone fractures in children requiring surgery were 55X more likely with low vitamin D same author as study on this page
Note: Vitamin D also PREVENTS Fractures