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

Abstract

Background: Vitamin D is an essential component in calcium metabolism. Seasonality, advanced age, sex, dark skin pigmentation, and limited exposure to sunlight were reported as causes of vitamin D deficiency. This study aims to determine whether children with lower levels of vitamin D suffer more fractures than those with sufficient levels. Materials and Methods: Our institution underwent a prospective case–control randomized cross-sectional single-blinded study that included 688 children. They were split into two groups: the study group and the control group. The study group received supplements of vitamin D and calcium for 6 months. Another reference cohort was observed, which comprised 889 patients in the pediatric ward for different respiratory or gastroenterological conditions without a history of fractures. This group was used for age–sex matching tests. Results: Logistic regression showed that with every one unit increase of vitamin D level, the chance of having a middle third fracture in both bones of the forearm decreased by 7% (OR 1.07); distal third fracture incidence decreased by 1.03 times; middle third radius fracture incidence decreased by 1.03 times; distal third radius fracture incidence decreased by 1.06 times. The risk of having a distal third both-bone forearm fracture increased by 1.06 times with every year of age. Comparing the healing process, we noticed an improvement in bony callus formation for patients in the study group. Conclusions: Dosing the serum level of 25-OH-vitamin D should be taken into consideration for pediatric low-energy trauma fractures. Supplementing with vitamin D and calcium throughout childhood can be a solution for healthy bones. Our preliminary results show that the normal level of vitamin D in children should start at 40 ng/mL.

Vitamin D and Osteogenesis Imperfecta in Pediatrics

“…Vitamin D is a pleiotropic hormone that plays a role in calcium–phosphorus metabolism as well as in the bone health [ 14 , 30 ]. Its proper supplementation in OI helps to prevent the secondary increase in PTH and the following increase in bone turnover [ 23 ].…”

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…However, early randomized controlled trials provided indirect evidence that calcium intake increases bone mineral density and reduces fracture risk, and a recent trial showed modest reduction in fracture incidence with vitamin D and calcium supplementation 171-175 . Malnutrition has shown to increase susceptibility to infections, prolong hospital LOS, and increase medical costs, whereas oral nutrient supplementation has shown to reduce hospital LOS and costs 12 .…”

“…The pediatric Subjective Global Nutrition Assessment has shown good correlation with serum albumin levels in predicting 30-day postoperative complications and prolonged hospital LOS after major surgery 169,170 . However, early randomized controlled trials provided indirect evidence that calcium intake increases bone mineral density and reduces fracture risk, and a recent trial showed modest reduction in fracture incidence with vitamin D and calcium supplementation [171][172][173][174][175] . Malnutrition has shown to increase susceptibility to infections, prolong hospital LOS, and increase medical costs, whereas oral nutrient supplementation has shown to reduce hospital LOS and costs 12 .…”

Traumatic injuries of the immature hip and pelvis

“…The rate of nonunion is reported as 6–33% [18] and is associated with inadequate reduction [50] and prolonged immobilization. This may also be improved with Vitamin D supplementation in deficient patients [14,21 ▪ ]. Premature growth arrest occurs in 5–65% of cases [23] and results from direct trauma to the physis or vascular injury at the time of fracture but may also be a consequence of surgical intervention, particularly if surgical implants cross the growth plate.…”

“…They are also usually caused by high energy trauma and are less commonly due to pathological bone lesions [20], birth trauma and seizures. Nonaccidental injury should be considered in nonambulatory patients [21 ▪ ]…”