Bone fractures in children requiring surgery were 55X more likely with low vitamin D

Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures.

J Pediatr Orthop. 2015 Jun 30.

Minkowitz B1, Cerame B, Poletick E, Nguyen JT, Formoso ND, Luxenberg SL, Lee BH, Lane JM; Morris-Essex Pediatric Bone Health Group.

1*Pediatric Orthopedic Surgery †Pediatric Endocrinology, Goryeb Children's Hospital at Atlantic Health System, Morristown, NJ ‡Hospital for Special Surgery, New York, NY.

Vitamin D Level	Increased Risk of severe fracture
< 12 ng	55.5 X
12-20 ng	6.7 X
20-30 ng	2.8 X
30-40 ng	1.7 X

BACKGROUND: There is growing concern over the relationship between the severity of pediatric fractures and low vitamin D [25-hydroxyvitaminD (25(OH)D)] status.

OBJECTIVE: Compare 25(OH)D levels and lifestyle of children with fractures to nonfracture controls to determine if 25(OH)D levels are associated with fractures and if there is a 25(OH)D fragility fracture threshold.

METHODS: Pediatric fracture and nonfracture controls were included. Bone health survey and medical record data were analyzed. Fractures were categorized using the Abbreviated Injury Scale (AIS). AIS 3 fractures were identified as fractures that required surgical intervention. Univariate and multivariable ordinal regression analyses were performed to identify potential risk factors for increased fracture severity.

RESULTS: A total of 369 fracture patients and 662 nonfracture controls aged 18 years and younger were included. Both groups' 25(OH)D levels were comparable. 25(OH)D was 27.5±8.9 in the fracture group compared with 27.4±9.1 ng/mL in nonfracture controls (P=0.914). AIS 3 fractures had lower 25(OH)D levels (24.6±9.3 ng/mL) versus AIS 1 and 2 (30.0±10.8 and 28.3±8.4, respectively, P=0.001). Univariate correlations for AIS severity were found with age (P=0.015) and outdoor playtime (P=0.042).

Adjusted odds ratios for

• 25(OH)D levels <12 ng/mL was 55.4 (P=0.037),

• 25(OH)D between 12 and 20 ng/mL was 6.7 (P=0.039),

• 25(OH)D between 20 and 30 ng/mL was 2.8 (P=0.208), and

• 25(OH)D between 30 and 40 was 1.7 (P=0.518).

CLINICAL RELEVANCE: Occurrence of a pediatric fracture was not associated with 25(OH)D levels in our study. However, children with lower vitamin D levels were found to be at higher risk for more severe fractures. Early evidence suggests that the target serum level for 25(OH)D should be at least 40 ng/mL in patients less than 18 years of age as the relative risk of more severe fractures increased as 25(OH)D levels decreased <40 ng/mL.

LEVEL OF EVIDENCE: Level III.

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See also VitaminDWiki

• 4X fewer stress fractures in college athletes if more than 40 ng of vitamin D – Feb 2016

• Acute fracture patients – 70 percent were vitamin D deficient – meta-analysis Sept 2015

• Hypothesis: increased bone mineral density needs protein, Ca, Mg, Vitamin D and K

• Bone strength (more accurate than BMD) is inversely associated with vitamin D level – May 2015

• Long bone fracture – prediction by low vitamin D is better than low BMD – Sept 2014

• Foot and Ankle Fracture Healing – vitamin D appears promising for everyone– review May 2015

• Overview Fractures and vitamin D

• Fractures reduced 30 percent by Omega-3 (Omega-3 activates vitamin D) – May 2015

• Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012

• Surgery for Pediatric Fracures 55 X more likely if < 12 ng of Vitamin D same author as study on this page

• 3 to 55 X more likely to have 63 health problems if low Vitamin D