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

Abstract

Background. Although it is generally agreed that vitamin D is important for bone health, the role of vitamin D in preventing fractures in children and adolescents remains unclear. Therefore, this study aimed to investigate the prevalence of vitamin D deficiency and insufficiency in healthy Korean children with fractures. Our secondary aim was to compare serum vitamin D levels before and during the coronavirus disease 2019 (COVID-19) outbreak. Methods. We evaluated 334 patients with fractures who were surgically treated at our institution between 2018 and 2019 before the onset of COVID-19 (group I). In addition, we collected data on the serum 25(OH)D levels of 210 patients who visited our pediatric department for evaluation of short stature (group II) and the serum 25(OH)D levels of the patients with fractures during the COVID-19 pandemic period (group III). A serum 25(OH)D level of <20 ng/mL was considered deficient, between 20 and 32 ng/mL was insufficient, and ≥32 ng/mL was considered sufficient. Results. The mean age was 8.1 ± 3.5 years in group I, 8.2 ± 3.7 years in group II, and 8.6 ± 3.5 years in group III. The prevalence of vitamin D deficiency was 53.0% in group I and 32.9% in group II. The mean serum 25(OH)D level was lower in group I than in group II (20.0 ± 7.3 ng/ml vs. 23.2 ± 6.9 ng/ml, p < 0.001 ). The mean serum 25(OH)D level of younger patients (<10 years) in group III was lower than that of the younger patients in the prepandemic period (21.4 ± 7.2 ng/mL vs. 19.2 ± 6.8 ng/mL, p = 0.037 ). Conclusions. We observed a high prevalence of vitamin D deficiency/insufficiency in children with fractures who required surgical treatment. During the COVID-19 pandemic, the serum vitamin D levels became even lower, especially in younger children.

Mediation Effect of Social Distancing on Neonatal Vitamin D Status and Related Clinical Outcomes during the Coronavirus Disease-19 Pandemic

“…Unlike changes in vitamin D levels in children and adolescents during the pandemic in previous reports, increased concentrations of serum vitamin D (22.4 ± 11.0 vs. 25.8 ± 12.5 ng/mL, p = 0.001) and a decreased rate of vitamin D deficiency in neonates during SD (47.1% vs. 35.4%, p = 0.008) were found in this study [16][17][18]. Since neonatal vitamin D status can be affected by maternal vitamin D, an increased rate of maternal vitamin D intake during SD may have contributed to the decreasing rate of neonatal vitamin D deficiency (Tables 2 and 4) [5,6,23].…”

“…Vitamin D deficiency is a growing health concern in both adults and children, especially during the pandemic period. During SD, vitamin D deficiency and decreased levels vitamin D were reported in infants and children [ 16 , 17 , 18 ]. Low vitamin D levels increased the risk of severe COVID-19 progression and related hospitalization [ 19 , 20 ].…”

Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review

“…The authors assumed that children’s lower extremity muscle strength and neuromuscular control decreased after staying at home for a prolonged period. In addition, in investigating the reasons for a higher fracture rate, Lee et al [ 65 ] found a higher prevalence of vitamin D deficiency in healthy Korean children with fractures during the pandemic.…”

“…The studies that examined the handling of patient volumes during the pandemic in more detail revealed interesting results in relation to more efficient procedures, particularly in the context of follow-up treatment and the use of X-rays without worsened outcomes [ 10 , 28 , 61 – 63 ]. Reduced mobility and more domestic activities are also sustainable factors to consider in bone health density in children during possible future lockdowns or in times of suspected reduced activity in children [ 35 , 65 , 66 ].…”

COVID-19 Inflammatory Markers and Vitamin D Relationship in Pediatric Patients

“…Moreover, in a study by Michael et al, supplementation of vitamin D in adults and elders proved to decrease the risk of mechanical ventilation and clinical severity in COVID-19 [ 46 ]. This is important, as studies by Lee et al and Beyazgul et al concluded that during the pandemic, the vitamin D levels of children were lower than before the pandemic, especially in younger children [ 47 , 48 ]. In our study, vitamin D levels were lower in younger children as well.…”