Vitamin D Deficiency: The Missing Etiological Factor in the Development of Juvenile Osteochondrosis Dissecans?
J Pediatr Orthop. 2016 Dec 22. doi: 10.1097/BPO.0000000000000921. [Epub ahead of print]
Maier GS1, Lazovic D, Maus U, Roth KE, Horas K, Seeger JB.
Healthy bones need Vitamin D, Magnesium, Vitamin K2, Boron, and protein
Bones are less healthy in those at high risk for low vitamin D
Examples: Obese, stay indoors a lot, concealing clothing, live far from equator, dark skin
Typical bone-health problems vs age
Low vitamin D in children can results in Rickets
Low Vitamin D in youths can result in Osteochondrosis Dissecans or shin splints
Low Vitamin D in older adults can result in Osteopenia
Low Vitamin D in seniors can result in Osteoarthritis and hip fractures
See also VitaminDWiki
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Vitamin D deficiency can result in rickets and hypocalcemia during infant and childhood growth. There is an increasing interest in the role of vitamin D with regards to childhood bone health. Osteochondrosis dissecans (OD) is a common disease affecting different joints. To date, the exact etiology of OD still remains unclear. The aim of this study was to evaluate a possible association of vitamin D deficiency and juvenile OD.
A retrospective chart review of the years 2010 to 2015 of all orthopaedic patients with an initial diagnosis of juvenile OD admitted to undergo operative treatment of the OD was performed. Patient demographics, medical history, information on sports activity (if available) and serum vitamin D (25-OH-D) level on admission date were obtained. For statistical comparison, we measured baseline prevalence of vitamin D insufficiency in age-matched orthopaedic patients presenting at the department of pediatric orthopaedics.
A total of 80 patients were included in this study. Overall, 97.5% (n=78) of tested patients in the OD group had serum vitamin D levels below the recommended threshold of 30 ng/mL (mean value of 10.1 ng/mL (±6.7 ng/mL)). Over 60% (n=49) were vitamin D deficient, 29 patients (37%) showed serum levels below 10 ng/mL corresponding to a severe vitamin D deficiency. Of note, only 2 patients (2.5%) reached serum vitamin D levels above the recommended threshold of 30 ng/mL.
No statistical difference was found in respect to sports activity level before onset of the symptoms (P=0.09).
Statistical analysis found a significant difference in vitamin D levels between patients with OD and patients without an OD (P=0.026).
We found an unexpected high prevalence of vitamin D deficiency in juveniles diagnosed with OD presenting with significant lower mean 25-OH-D level compared with a control group. These results suggest that vitamin D deficiency is potentially associated with the development of OD. Thus, vitamin D deficiency might be an important cofactor in the multifactorial development of juvenile OD. For this reason, supplementation of vitamin D might not only be a potential additional therapy but also be a possible preventative factor in patients with juvenile OD. However, future prospective studies are needed to confirm this preliminary data.
LEVEL OF EVIDENCE: Level III-this is a case-control study.
PMID: 28009798 DOI: 10.1097/BPO.0000000000000921
PDF is behind a publisher paywall
The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents.
Am J Sports Med. 2014 Feb;42(2):320-6. doi: 10.1177/0363546513510390. Epub 2013 Nov 22.
Kessler JI1, Nikizad H, Shea KG, Jacobs JC Jr, Bebchuk JD, Weiss JM.
1Jeffrey I. Kessler, Kaiser Permanente Southern California, 4760 Sunset Boulevard, Los Angeles, CA 90027. Jeffrey.I.Kessler at kp.org.
Osteochondritis dissecans (OCD) is a disorder of subchondral bone and articular cartilage whose incidence in children is not clearly known.
The purpose of this study was to assess the demographics and epidemiology of OCD of the knee in children.
Descriptive epidemiology study.
A retrospective chart review of an integrated health system was performed on patients with OCD of the knee aged 2 to 19 years from 2007 to 2011, with over 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. The incidence of OCD was determined for the group as a whole and by sex and age group (2-5 years, 6-11 years, and 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and using multivariable logistic regression models, associations between age, sex, ethnicity, and diagnosis of OCD of the knee were evaluated.
One hundred ninety-two patients with 206 OCD lesions of the knee fit the inclusion criteria. No OCD lesion of the knee was found in 2- to 5-year-old children. One hundred thirty-one (63.6%) lesions were in the medial femoral condyle, 67 (32.5%) were in the lateral femoral condyle, 96 (50.0%) lesions were right sided, 82 (42.7%) were left sided, and 14 (7.3%) were bilateral.
The incidence of patients with OCD of the knee aged 6 to 19 years was 9.5 per 100,000 overall and 15.4 and 3.3 per 100,000 for male and female patients, respectively.
Those aged 12 to 19 years represented the vast majority of OCD, with an incidence of 11.2 per 100,000 versus 6.8 per 100,000 for those aged 6 to 11 years. For those aged 6 to 11 and 12 to 19 years, female patients had an incidence of 2.3 and 3.9 per 100,000, respectively, while male patients had an incidence of 11.1 and 18.1 per 100,000, respectively.
Multivariable logistic regression analysis revealed a 3.3-fold increased risk of OCD of the knee in patients aged 12 to 19 years compared with those aged 6 to 11 years (P < .001; 95% confidence interval [CI], 2.37-4.48), and male patients had 3.8 times a greater risk of OCD of the knee than female patients (P < .001; 95% CI, 2.71-5.41). Based on race and ethnicity, blacks had the highest odds ratio of OCD of the knee compared with all other ethnic groups.
In this population-based cohort study of pediatric OCD of the knee, male patients had a much greater incidence of OCD and almost 4 times the risk of OCD compared with female patients. Also, patients aged 12 to 19 years had 3 times the risk of OCD of the knee as compared with 6- to 11-year-old children.
PMID: 24272456 DOI: 10.1177/0363546513510390
From the PDF – twice as likely in blacks compared to whites - no mention of vitamin D
From https://en.wikipedia.org/wiki/Osteochondritis_dissecans Dec 2016
In osteochondritis dissecans, fragments of cartilage or bone become loose within a joint, leading to pain and inflammation.
These fragments are sometimes referred to as joint mice. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. OCD most commonly affects the knee, although it can affect other joints such as the ankle or the elbow.
People with OCD report activity-related pain that develops gradually. Individual complaints usually consist of mechanical symptoms
including pain, swelling, catching, locking, popping noises, and buckling / giving way; the primary presenting symptom may be a restriction in the range of movement.
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