Low Vitamin D Levels in Children with Fractures: A Comparative Cohort Study

Abstract

BackgroundThe currently accepted ranges for “normal” serum vitamin D have recently been challenged in adults on the basis that healthy bone metabolism requires higher levels of vitamin D than previously thought.PurposeThe purpose of this study was to evaluate whether a new “biologically based” classification based on 25(OH)vitamin D levels that invoke an endocrine biomarker response (<20 ng/mL for deficiency and <32 ng/mL for insufficiency) is more appropriate for children with fractures than historical criteria.MethodsSerum 25(OH)vitamin D levels were collected from 58 children with acute low-energy fractures from an outpatient orthopedic clinic from 2009 to 2012. These vitamin D levels were compared with a cohort of 103 children with chronic kidney disease (CKD) from an adjacent clinic, a condition with acknowledged low levels of vitamin D. Then, the prevalence of vitamin D sufficiency in the fracture cohort was evaluated and compared using both historical guidelines and newer biologically based criteria.Results25(OH)vitamin D levels in the fracture cohort did not differ from levels in the CKD cohort (27.5 vs. 24.6 ng/mL) indicating a similar distribution of vitamin D levels. This finding was consistent when controlling for significant covariables using linear regression analyses. In the fracture cohort, there was a discrepancy between historical and biologically based criteria in 64% of children.ConclusionsThe results of the current study suggest that fracture patients are more frequently vitamin D deficient than previously thought. This finding is more readily apparent when newer biologically based criteria for vitamin D sufficiency are used.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-015-9447-7) contains supplementary material, which is available to authorized users.

Vitamin D—A Risk Factor for Bone Fractures in Children: A Population-Based Prospective Case–Control Randomized Cross-Sectional Study

“…In agreement with the results from an 11-year study in Sweden, at least one-third of children under 17 years will suffer one or more fractures [ 23 ]. There is a series of studies in pediatric orthopedics that suggests a link between the plasma level of vitamin D and the occurrence of fractures [ 24 , 25 , 26 , 27 , 28 ].…”

“…Some authors suggest reconsidering these target levels based on age groups and medical conditions [ 28 ]. Some experts consider that patients with bone fragility should have a higher level of D3 and should be treated with an initial higher dose followed by maintenance.…”

Prevalence of Vitamin D Deficiency in Children with Fractures: Before and during the COVID-19 Outbreak

“…For example, the Institute of Medicine places the optimal level at 20 ng/mL, whereas the Endocrine Society defines it as > 30 ng/mL [ 14 , 15 ]. The Endocrine Society is the most frequently used definition with deficiency defined as < 20 ng/mL, insufficiency as ≤ 30 ng/mL, and sufficiency as > 30 ng/mL [ 16 ]. However, we defined deficiency as < 20 ng/mL since there is evidence to suggest that there is a significant difference in bone quality in individuals with a serum vitamin D level of 20 vs. 30 ng/mL.…”

“…However, we defined deficiency as < 20 ng/mL since there is evidence to suggest that there is a significant difference in bone quality in individuals with a serum vitamin D level of 20 vs. 30 ng/mL. [ 16 ] Furthermore, a recent comparative cohort study from Fabricant et al showed that pediatric patients with low-energy fractures had low serum 25(OH)D levels comparable to individuals with chronic kidney disease (27.5 ng/mL and 24.6 ng/mL, respectively). [ 16 ] Therefore, they suggest using a cutoff of 32 ng/mL for vitamin D insufficiency as more appropriate for children.…”

“…[ 16 ] Furthermore, a recent comparative cohort study from Fabricant et al showed that pediatric patients with low-energy fractures had low serum 25(OH)D levels comparable to individuals with chronic kidney disease (27.5 ng/mL and 24.6 ng/mL, respectively). [ 16 ] Therefore, they suggest using a cutoff of 32 ng/mL for vitamin D insufficiency as more appropriate for children.…”