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

Overview

Journal Children (Basel)

Specialty Health Services

Date 2022 May 28

PMID 35626939

Authors

Sinisa Ducic

Filip Milanovic

Mikan Lazovic

Bojan Bukva

Goran Djuricic

Vladimir Radlovic

Dejan Nikolic

Affiliations

Soon will be listed here.

Abstract

Background: The forearm is the most common fracture site in childhood, accounting for every fourth pediatric fracture. It is well described that vitamin D is involved in the regulation of bone mineralization and skeletal homeostasis by the regulation of calcium absorption. The aim of our study was to determine the influence of 25-hydroxyvitamin D levels on forearm fracture falls in a pediatric population, depending on level of energy impact. Additionally, we also aimed to evaluate the correlation between 25-hydroxyvitamin D levels and other tested risk factors for pediatric fractures. Methods: We evaluated 50 eligible children aged 3 to 12 years with a forearm fracture. According to energy impact, patients were grouped into low-energy fractures (LEF) and high-energy fractures (HEF) groups. The general characteristics of the patients included age, gender, sport participation, and fractured bone and its localization. We analyzed 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium, phosphate, C-reactive protein (CRP) levels, and body mass index (BMI). Results: There is a significant difference in the 25-hydroxyvitamin D levels distribution between LEF and HEF (p < 0.001) and PTH levels (p = 0.002). For magnesium levels, calcium levels, phosphate levels, and CRP levels, there were no significant differences in their frequency distribution. For the group of patients with LEF, there is a significantly positive correlation between 25-hydroxyvitamin D and calcium levels (p = 0.019) and a borderline significantly positive correlation between 25-hydroxyvitamin D and magnesium levels (p = 0.050). For the group of patients with HEF, there was only a significantly positive correlation between 25-hydroxyvitamin D and PTH levels (p < 0.001). Conclusions: Children with LEF were more frequently insufficient in 25-hydroxyvitamin D levels but had normal calcium levels, compared to the ones with HEF. These findings suggest that LEF and HEF in children might to a certain degree have different pathophysiological mechanisms.

Citing Articles

Bone Health in Young Athletes: a Narrative Review of the Recent Literature.

Armento A, Heronemus M, Truong D, Swanson C Curr Osteoporos Rep. 2023; 21(4):447-458.

PMID: 37289381 PMC: 10248337. DOI: 10.1007/s11914-023-00796-5.

References

Guifo M, Tochie J, Oumarou B, Moulion Tapouh J, Bang A, Ndoumbe A . Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes. Pan Afr Med J. 2017; 27:46. PMC: 5554657. DOI: 10.11604/pamj.2017.27.46.11485. View

Ryan L, Teach S, Singer S, Wood R, Freishtat R, Wright J . Bone mineral density and vitamin D status among African American children with forearm fractures. Pediatrics. 2012; 130(3):e553-60. PMC: 3428759. DOI: 10.1542/peds.2012-0134. View

Reimers A, Schoeppe S, Demetriou Y, Knapp G . Physical Activity and Outdoor Play of Children in Public Playgrounds-Do Gender and Social Environment Matter?. Int J Environ Res Public Health. 2018; 15(7). PMC: 6069007. DOI: 10.3390/ijerph15071356. View

Maatta M, Macdonald H, Mulpuri K, McKay H . Deficits in distal radius bone strength, density and microstructure are associated with forearm fractures in girls: an HR-pQCT study. Osteoporos Int. 2015; 26(3):1163-74. PMC: 4889426. DOI: 10.1007/s00198-014-2994-9. View

Moore D, OSullivan M, Kiely P, Noel J, OToole P, Kennedy J . Vitamin D levels in Irish children with fractures: A prospective case-control study with 5 year follow-up. Surgeon. 2021; 20(2):71-77. DOI: 10.1016/j.surge.2021.02.015. View

. School health guidelines to promote healthy eating and physical activity. MMWR Recomm Rep. 2011; 60(RR-5):1-76. View

Thompson R, Dean D, Goldberg S, Kwasny M, Langman C, Janicki J . Vitamin D Insufficiency and Fracture Risk in Urban Children. J Pediatr Orthop. 2015; 37(6):368-373. DOI: 10.1097/BPO.0000000000000697. View

Chaput J, Willumsen J, Bull F, Chou R, Ekelund U, Firth J . 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. Int J Behav Nutr Phys Act. 2020; 17(1):141. PMC: 7691077. DOI: 10.1186/s12966-020-01037-z. View

Benenson J, Carder H, Geib-Cole S . The development of boys' preferential pleasure in physical aggression. Aggress Behav. 2007; 34(2):154-66. DOI: 10.1002/ab.20223. View

10.

Oyen J, Apalset E, Gjesdal C, Brudvik C, Lie S, Hove L . Vitamin D inadequacy is associated with low-energy distal radius fractures: a case-control study. Bone. 2011; 48(5):1140-5. DOI: 10.1016/j.bone.2011.01.021. View

11.

Gorter E, Oostdijk W, Felius A, Krijnen P, Schipper I . Vitamin D Deficiency in Pediatric Fracture Patients: Prevalence, Risk Factors, and Vitamin D Supplementation. J Clin Res Pediatr Endocrinol. 2016; 8(4):445-451. PMC: 5198004. DOI: 10.4274/jcrpe.3474. View

12.

Lips P . Vitamin D physiology. Prog Biophys Mol Biol. 2006; 92(1):4-8. DOI: 10.1016/j.pbiomolbio.2006.02.016. View

13.

Donnelly J, Hillman C, Castelli D, Etnier J, Lee S, Tomporowski P . Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review. Med Sci Sports Exerc. 2016; 48(6):1197-222. PMC: 4874515. DOI: 10.1249/MSS.0000000000000901. View

14.

Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E . Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr. 2018; 44(1):51. PMC: 5941617. DOI: 10.1186/s13052-018-0488-7. View

15.

El-Sakka A, Penon C, Hegazy A, Elbatrawy S, Gobashy A, Moreira A . Evaluating Bone Health in Egyptian Children with Forearm Fractures: A Case Control Study. Int J Pediatr. 2016; 2016:7297092. PMC: 5019920. DOI: 10.1155/2016/7297092. View

16.

Hosseinzadeh P, Mohseni M, Minaie A, Kiebzak G . Vitamin D Status in Children With Forearm Fractures: Incidence and Risk Factors. J Am Acad Orthop Surg Glob Res Rev. 2020; 4(8):e20.00150-5. PMC: 7447362. DOI: 10.5435/JAAOSGlobal-D-20-00150. View

17.

Vescio A, Testa G, Sapienza M, Caldaci A, Montemagno M, Andreacchio A . Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?. Children (Basel). 2022; 9(3). PMC: 8947058. DOI: 10.3390/children9030425. View

18.

Yang G, Lee W, Hung A, Tang M, Li X, Kong A . Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Osteoporos Int. 2021; 32(7):1287-1300. DOI: 10.1007/s00198-020-05814-1. View

19.

Ryan L, Brandoli C, Freishtat R, Wright J, Tosi L, Chamberlain J . Prevalence of vitamin D insufficiency in African American children with forearm fractures: a preliminary study. J Pediatr Orthop. 2010; 30(2):106-9. PMC: 2847369. DOI: 10.1097/BPO.0b013e3181d076a3. View

20.

Cheng J, Lam T, Maffulli N . Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001; 10(1):63-7. View