Vitamin D level, body mass index and fracture risk in children: vitamin D deficiency and fracture risk

Abstract

The objective of this study was to determine the impacts of preventable causes of fracture, such as vitamin D deficiency, disturbed calcium homeostasis and obesity on fracture occurrence in minor traumas. In this way, the effects of relevant parameters on fracture may be further elucidated. A prospective case-control study in children aged 2-18 years children with and without fractures was performed. Participants with a pediatric trauma score higher than 10 presenting to minor trauma were included to exclude the significant impact of severe trauma on fracture. The effects of obesity, parameters associated with vitamin D and Ca homeostasis on fracture occurrence were evaluated. Univariate and multivariate analyses were used to test for associations between fracture status and the assessed variables. The relationships between the variables and the odds of fracture occurrence were examined using logistic regression models. The sample consisted of 76 patients and 50 controls. There were no significant differences between the patients and controls in terms of age, sex, trauma type and pubertal period. The patients had a significantly higher mean BMI percentile (61.2 ± 30.7, 36.7 ± 30.7; P < 0.001). Likewise, patients were more likely than controls to have a lower mean 25(OH)D level and mean phosphorus level (respectively, 13.4 ± 7.0, 17.3 ± 7.8; P = 0.004, and 4.6 ± 0.7, 5.1 ± 0.8; P < 0.001). Moreover, fractures were substantially more frequent in children with vitamin D deficiency (<20 ng/ mL, χ 2 : 7.781, df: 1, P = 0.005). In the multivariate logistic model, BMI percentile and vitamin D levels remained significantly associated with increased odds of fracture [1.02 (1.01-1.04), P < 0.001 and 0.93 (0.89-0.98), P = 0.01]. The present study supports an association of high BMI and vitamin D deficiency with an increased odds of fracture occurrence in children. The findings may help physicians to reduce the risk factors of fracture by preventive efforts. Thus, unexpected health costs and morbidity may be minimized.

Relationship Between Hypovitaminosis D and Fractures Among Adolescents With Overweight or Obesity

“…20 In spite of its role in calcium homeostasis and the known link between 25(OH)D deficiency and rickets, the association between 25(OH)D deficiency and fracture risk has not been fully established. 4,[21][22][23][24][25][26][27][28][29][30] Some studies have examined the high prevalence of 25(OH)D deficiency among children with fractures, and a few of them compared children with fractures to "non-fractured" control subjects. 20,31 A recent meta-analysis by Yang et al 24 found an association between 25(OH)D insufficiency and a higher risk for fractures in children while other studies reported no association between vitamin D deficiency and fractures in children and adolescents.…”

Mycophenolic Acid Exposure Optimization Based on Vitamin D Status in Children with Systemic Lupus Erythematosus: A Single-Center Retrospective Study

“…Chronic glucocorticoid use in children with SLE could lead to abnormal bone metabolism and growth [ 6 , 9 , 30 ]. Studies have shown that serum 25(OH)D levels of 15 ng/mL or less are independently associated with a lower bone formation rate and an increased fracture risk [ 31 ] in adults as well as in children [ 32 ]. In our study, higher 25(OH)D levels were found to be positively associated with higher levels of serum calcium and lower levels of phosphorus, which is related to the role of parathyroid hormone in regulating the levels of calcium under the circumstances of vitamin D deficiency and hypocalcemia [ 5 ].…”

Vitamin-D level, body mass index and fracture risk in children: vitamin-D deficiency and fracture risk. Varkal MA, Gulenc B, Yildiz I, Kandemir I, Bilgili F, Toprak S, et al. J Pediatr Orthop B 2022; 31:e264–e270

“…Varkal et al [1] quoted Kelley et al [4] as a reference for their statement that obesity is associated with increased fracture risk in childhood. However, Kelley et al [4] claimed that obese adolescents ≥10 to <15 years of age (childhood is defined as 3-11 years of age) have an increased fracture risk without investigating fractures in their study.…”

“…Varkal et al [1] referenced Goulding et al [6] as evidence for children with obesity and high BMI having a higher fracture frequency but the latter authors [6] identified that there was no significant difference in BMI, weight or fat and lean mass between the fracture and nonfracture group. Goulding et al [7] listed four risk factors for forearm fractures which were over-represented in observed versus expected percentages of which obesity was the weakest variable (33.3 versus 15.5%) compared to low dietary calcium intake (20 versus 4.5%), adverse symptoms to cow milk (22.2 versus 6.7%) and early age of first fracture (27.7 versus 11.3%).…”

“…We read with interest the publication by Varkal et al [1], ‘Vitamin-D level, BMI and fracture risk in children: vitamin-D deficiency and fracture risk’.…”