Vitamin d sufficiency screening in preoperative pediatric orthopaedic patients.

J Pediatr Orthop. 2011 Apr-May;31(3):331-3.
Parry J, Sullivan E, Scott AC.
University of Texas Medical School at Houston †Shriners Hospital for Children, Houston, TX.

BACKGROUND: Vitamin D is a critical factor in bone metabolism. Vitamin D levels in both children and adults have been reevaluated to assess standards for sufficiency and deficiency. In the adult population, the currently recommended level for Vitamin D sufficiency is greater than 32 ng/mL measured by 25-hydroxyvitamin D assay. Recommended levels for growing children have not been definitively determined; however, scales based on available literature have been used. The purpose of this study was to evaluate Vitamin D sufficiency in pediatric orthopaedic patients admitted to the hospital for surgical procedures which require bone healing.

METHODS: Serum 25 hydroxyvitamin D (25 OHD) levels measured by immunochemoluminometric assay were obtained on consecutive pediatric orthopaedic patients admitted electively for long bone osteotomies or spinal fusions over a 10-month period. Seventy patients ranging in age from 2 to 19 years were screened for Vitamin D sufficiency. Vitamin D levels were examined for correlation with age, sex, ethnicity, body mass index (BMI), BMI percentile, orthopaedic diagnosis, and season.

RESULTS: Total 90% of the screened patients had 25 OH vitamin D levels below 32 ng/mL.
African American children were more likely to have severe Vitamin D deficiency (P=0.013).
Vitamin D levels were lower in the winter months (P=0.046).
When 20 ng/mL was used as a cutoff, the average age of children below this cutoff was higher than those above (P=0.018).
There was no correlation of Vitamin D levels with sex, BMI, BMI percentile, residence in Mexico, and diagnosis.

CONCLUSIONS: Total 90% of the children in the screening group were at risk for poor bone healing owing to Vitamin D deficiency or insufficiency. African American children, in particular, should be evaluated for Vitamin D sufficiency before orthopaedic surgeries. Further work must be done to determine the impact of Vitamin D insufficiency on surgical outcomes.

LEVEL OF EVIDENCE: Diagnostic study, III.

PMID: 21415696
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