The clinical and biochemical presentation of vitamin D deficiency and insufficiency in children and adolescents.
Journal of Pediatric Endocrinology and Metabolism. 2013 Feb 20:1-7. doi: 10.1515/jpem-2012-0245.
Torun E, Genç H, Gönüllü E, Akovalı B, Ozgen IT.
1 Department of Pediatrics, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
2 Department of Biochemistry, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
3 Department of Pediatric Endocrinology and Metabolism, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
Corresponding author: Emel Torun, Department of Pediatrics, Medical Faculty, Bezmialem Vakif University Hospital, Adnan Menderes Avenue P.K.: 34093 Fatih/Istanbul, Turkey, Phone: +90 212 4531700, Fax: +90 212 6217580
Aim: To evaluate the clinical and biochemical findings of the children and adolescents with vitamin D deficiency and insufficiency in order to determine the clinical and biochemical presentation differences between age groups.
Methods: This retrospective study included a review of medical reports of 543 patients (aged between 1-17 years) who were referred to our hospital between October 2011 and May 2012 with symptoms related to vitamin D deficiency or insufficiency.
The patients were divided into four groups by age: 1-3 years (Group 1), 4-6 years (Group 2), 7-11 years (Group 3) and 12-17 years (Group 4). Patients diagnosed with vitamin D deficiency or insufficiency were evaluated as to their clinical and biochemical findings.
Results: Gender distribution were not statistically different between the four groups. The mean ages of Groups 1-4 were 1.9±0.7, 5.1±0.9, 8.9±1.3, 13.1±1.1, respectively. Major complaints on admission were muscle weakness (91%), low weight gain (failure to thrive) (89%), head deformity (frontal bossing) (35.6%), bone deformity (enlargement of wrist and ankles) (29.7%) for Group 1. Muscle weakness (76%) and low weight gain (failure to thrive) (68%) for Group 2. Leg and chest pain were the major symptoms in Group 3 (57% and 28%, respectively) and in Group 4 (26% and 55%, respectively) as well as high rates of obesity (31% and 63%). The biochemical findings of vitamin D deficiency mostly appeared in the first group who developed vitamin D deficiency due to the lack of vitamin D supplementation. However, in older children, the majority of the patients had low 25 hydroxyvitamin D (25 OHD) values without evidence of biochemical findings of osteomalacia.
Conclusion: Depending on the degree of deficiency and insufficiency, and the age of the patients, the clinical and biochemical findings varied widely. Children under the age of 3 who either never received vitamin D supplementation or who had been receiving supplementation that was stopped too early were at a greater risk for developing clinically and biochemically proved vitamin D deficiency. In older children, low vitamin D levels mostly resulted in subtle complaints without abnormal biochemical findings.
|1-3 years (G1)||4-6 years (G2)||7-11 years (G3)||12-17 years (G4)|
|muscle weakness (91%)|
low weight gain (failure to thrive) (89%),
head deformity (frontal bossing) (35.6%),
bone deformity (29.7%)
(enlargement of wrist & ankles)
|Muscle weakness (76%) |
low weight gain (failure to thrive) (68%)
| Leg pain (57%)|
Chest pain (28%)
high rates of obesity (31%)
|Leg Pain (26%) |
Chest pain (55%)
high rates of obesity (63%)