Vitamin D compliance 3X higher when children with fractures actually knew their low vitamin D level

Created April 2019

Obtaining Vitamin D Levels in Children With Fractures Improves Supplementation Compliance

Journal of Pediatric Orthopaedics: March 06, 2019 – doi: 10.1097/BPO.0000000000001363

Minkowitz, Barbara, MD; Nadel, Leah, BA†; McDermott, Meghan, BA†; Cherna, Zachary, BS; Ristic, Jennifer, PA-C, MMSc*; Chiu, Stephanie, MPH‡ AHS Bone Health Compliance Group

Compliance = take at least 4 out of 7 daysNote: Study did not even consider the increased compliance from1. Less frequent dosing1. Starting with a loading dose so the benefits can be felt in days instead of months1. Recommending that could take missed pills in a single day* Example - put 30 pills in a cup at the beginning of each month and just be sure that there are none at the end of the month1. Not really have to swallow pills - alternately use liquid, powder, topical, inhaled, etc,---* Search Vitamin D Life for COMPLIANCE 1470 items as of April 2019* * Intervention - non daily category listing has Randomized Clinical Trials * * Typically 1, 2, or 4 per month* Vitamin D – monthly dosing was better than daily with Calcium – RCT Dec 2015* Vitamin D every 25 days may be BETTER than daily – RCT May 2018* Monthly 100,000 IU of vitamin D is safe (and may be better than daily) – RCT Aug 2018* Vitamin D given weekly better than daily (Nursing home, 5,600 IU weekly) – Aug 2018* Monthly vitamin D dosing had higher response than 3 per month – RCT Jan 2018* Monthly vitamin D dosing is better than daily dosing for children and elderly (more likely to be taken) – June 2017* Far more Vitamin D in breast milk from a 150,000 IU dose than from daily 5,000 IU – RCT May 2018* Take vitamin D3 daily, weekly, or bi-weekly discusses concentration gradient from infrequent dosing* Adherence of children taking vitamin D supplements – Aug 2013

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Background: Obtaining ideal serum 25-vitamin D (25VitD) levels (>30 ng/mL) is imperative in childhood to achieve peak bone mass. Supplementation compliance in children recommended to take vitamin D postfracture was evaluated. The questions we sought to answer were: Is there (1) a compliance difference between patients with known versus unknown 25VitD levels; (2) an association between compliance and age; and (3) an association between fracture severity and initial 25VitD level.

Methods: One physician analyzed compliance in 1818 fracture patients 2 to 18 years (42% female) with known (48%) and unknown 25VitD. Patient/caregiver’s self-reported adherence to supplementation as “yes” (4 d/wk minimum) or “no” defined compliance. Compliance relating to fracture severity via Abbreviated Injury Scale (AIS) , 25VitD level, and age, was analyzed.

Results: Patients with 25VitD levels were more compliant than patients without ( 61% , n=532/872; 21% , n=206/946; P<0.001). In total, 83% (n=104/125) of AIS 3 patients were compliant, compared with 49% (n=628/1292) of AIS 1/2 patients (P<0.001). Compliance increased with age (odds ratio: 1.09, 95% confidence interval: 1.061-1.120, P<0.001).

Conclusions: Compliance increased when 25VitD levels were obtained, improving with fracture severity. Clinicians should order 25VitD levels on fracture patients to improve supplementation compliance.

Level of Evidence: This is a level IV prognostic study which aims to investigate the effects of various patient characteristics on compliance.