Vitamin D Status in Children With Forearm Fractures: Incidence and Risk Factors

Overview

Journal J Am Acad Orthop Surg Glob Res Rev

Specialty Orthopedics

Date 2020 Aug 28

PMID 32852920

Citations 4

Authors

Pooya Hosseinzadeh

Mahshid Mohseni

Arya Minaie

Gary M Kiebzak

Affiliations

Soon will be listed here.

Abstract

Introduction: The association between vitamin D status and fracture characteristics in children remains ambiguous. We hypothesized that vitamin D deficient or insufficient children would have an increased risk of forearm fractures severe enough to require surgical management.

Methods: One hundred children with low-energy forearm fractures were prospectively enrolled from a single hospital. Each participant answered a questionnaire focusing on the risk factors for vitamin D deficiency. Fractures were categorized as requiring nonsurgical or surgical management. Vitamin D status was based on the measurement of 25-hydroxyvitamin D (25(OH)D) concentration obtained during the clinic visit and compared between the two fracture groups.

Results: The cohort exhibited a mean age of 9.8 ± 3.2 years (range: 3-15 years), comprising 65 (65%) men and 35 (35%) women. Overall, mean 25(OH)D was 27.5 ± 8.3 ng/mL. Using the Endocrine Society guidelines, 21% of patients were categorized as "vitamin D deficient" (25(OH)D ≤ 20 ng/mL) and 49% as "vitamin D insufficient" (25(OH)D: 21 to 29 ng/mL). Stratification by intervention revealed a mean 25(OH)D of 23.3 ± 8.8 ng/mL in the surgical group (n = 12) and 28.1 ± 8.1 in the nonsurgical group (n = 88) (P = 0.057). Fifty percent of the surgical group were "vitamin D deficient" compared with 17% of the nonsurgical group (P = 0.017). The relative risk of requiring surgical treatment in children with forearm fracture and vitamin D deficiency (25(OH)D < 20 ng/mL) was 3.8. 25(OH)D level, negatively correlated with body mass index (r = -0.21, P = 0.044); 9 surgical patients were overweight or obese (as defined by the criteria of the Centers for Disease Control and Prevention). 25(OH)D level was significantly lower in non-Caucasians compared with Caucasians (26.0 ± 7.2 versus 32.5 ± 9.9 ng/mL; P = 0.0008).

Discussion: Vitamin D deficiency is common in children with forearm fractures and may be a contributing risk factor for forearm fractures requiring surgical management in children.

Conclusion: Vitamin D deficiency and inefficiency are common in children with low energy forearm fractures, especially in obese children and in fractures requiring surgical treatment.

Citing Articles

Vitamin D Levels During Fracture Healing in Children.

Hendrych J, Bayer M, Havranek P, cepelik M, Pesl T Physiol Res. 2025; 73(6):1063-1074.

PMID: 39903895 PMC: 11835215.

Obesity and Skeletal Fragility.

Chen R, Armamento-Villareal R J Clin Endocrinol Metab. 2023; 109(2):e466-e477.

PMID: 37440585 PMC: 10795939. DOI: 10.1210/clinem/dgad415.

Vitamin D Supplementation and Its Impact on Different Types of Bone Fractures.

Erdmann J, Wicinski M, Szyperski P, Gajewska S, Ohla J, Slupski M Nutrients. 2023; 15(1).

PMID: 36615761 PMC: 9824692. DOI: 10.3390/nu15010103.

Vitamin D and Forearm Fractures in Children Preliminary Findings: Risk Factors and Correlation between Low-Energy and High-Energy Fractures.

Ducic S, Milanovic F, Lazovic M, Bukva B, Djuricic G, Radlovic V Children (Basel). 2022; 9(5).

PMID: 35626939 PMC: 9139354. DOI: 10.3390/children9050762.

Comparison of 25-OH vitamin D levels between children with upper and those with lower extremity fractures: A prospective case-control study.

Ergun T, Cansever M Acta Orthop Traumatol Turc. 2022; 56(2):76-80.

PMID: 35416156 PMC: 9612657. DOI: 10.5152/j.aott.2022.21018.

References

Larrosa M, Gomez A, Casado E, Moreno M, Vazquez I, Orellana C . Hypovitaminosis D as a risk factor of hip fracture severity. Osteoporos Int. 2011; 23(2):607-14. DOI: 10.1007/s00198-011-1588-z. View

Moon R, Harvey N, Davies J, Cooper C . Vitamin D and skeletal health in infancy and childhood. Osteoporos Int. 2014; 25(12):2673-84. PMC: 4224585. DOI: 10.1007/s00198-014-2783-5. View

Contreras J, Hiestand B, ONeill J, Schwartz R, Nadkarni M . Vitamin D deficiency in children with fractures. Pediatr Emerg Care. 2014; 30(11):777-81. DOI: 10.1097/PEC.0000000000000258. View

Cauley J, LaCroix A, Wu L, Horwitz M, Danielson M, Bauer D . Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med. 2008; 149(4):242-50. PMC: 2743412. DOI: 10.7326/0003-4819-149-4-200808190-00005. View

Jones I, Williams S, Dow N, Goulding A . How many children remain fracture-free during growth? a longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study. Osteoporos Int. 2002; 13(12):990-5. DOI: 10.1007/s001980200137. View

Nellans K, Kowalski E, Chung K . The epidemiology of distal radius fractures. Hand Clin. 2012; 28(2):113-25. PMC: 3345129. DOI: 10.1016/j.hcl.2012.02.001. View

Lee J, So T, Thackray J . A review on vitamin d deficiency treatment in pediatric patients. J Pediatr Pharmacol Ther. 2014; 18(4):277-91. PMC: 3979050. DOI: 10.5863/1551-6776-18.4.277. View

Kessler J, Koebnick C, Smith N, Adams A . Childhood obesity is associated with increased risk of most lower extremity fractures. Clin Orthop Relat Res. 2012; 471(4):1199-207. PMC: 3586019. DOI: 10.1007/s11999-012-2621-z. View

Whiting S . Obesity is not protective for bones in childhood and adolescence. Nutr Rev. 2002; 60(1):27-30. DOI: 10.1301/002966402760240327. View

10.

Clark E, Ness A, Bishop N, Tobias J . Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res. 2006; 21(9):1489-95. PMC: 2742714. DOI: 10.1359/jbmr.060601. View

11.

Newman M, Brandon T, Groves M, Gregory W, Kapur S, Zava D . A liquid chromatography/tandem mass spectrometry method for determination of 25-hydroxy vitamin D2 and 25-hydroxy vitamin D3 in dried blood spots: a potential adjunct to diabetes and cardiometabolic risk screening. J Diabetes Sci Technol. 2010; 3(1):156-62. PMC: 2769851. DOI: 10.1177/193229680900300118. View

12.

Pennock A, Gantsoudes G, Forbes J, Asaro A, Mubarak S . Stair falls: caregiver's "missed step" as a source of childhood fractures. J Child Orthop. 2014; 8(1):77-81. PMC: 3935023. DOI: 10.1007/s11832-014-0551-x. View

13.

Cooper C, Dennison E, Leufkens H, Bishop N, van Staa T . Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res. 2004; 19(12):1976-81. DOI: 10.1359/JBMR.040902. View

14.

Wagner C, Greer F . Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008; 122(5):1142-52. DOI: 10.1542/peds.2008-1862. View

15.

Gower B, Casazza K . Divergent effects of obesity on bone health. J Clin Densitom. 2013; 16(4):450-4. PMC: 5321047. DOI: 10.1016/j.jocd.2013.08.010. View

16.

Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R . Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(7):1911-30. DOI: 10.1210/jc.2011-0385. View

17.

Davidson P, Goulding A, Chalmers D . Biomechanical analysis of arm fracture in obese boys. J Paediatr Child Health. 2003; 39(9):657-64. DOI: 10.1046/j.1440-1754.2003.00243.x. View

18.

Minkowitz B, Cerame B, Poletick E, Nguyen J, Formoso N, Luxenberg S . Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures. J Pediatr Orthop. 2015; 37(1):23-29. DOI: 10.1097/BPO.0000000000000587. View

19.

Ryan L . Forearm fractures in children and bone health. Curr Opin Endocrinol Diabetes Obes. 2010; 17(6):530-4. DOI: 10.1097/MED.0b013e32833e9c8b. View

20.

Ryan L, Teach S, Searcy K, Singer S, Wood R, Wright J . The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls. Pediatr Emerg Care. 2015; 31(12):835-8. DOI: 10.1097/PEC.0000000000000628. View