Association of Vitamin D Levels and Pediatric Long Bone Fractures in Vajira Hospital: A Case-Control Study
DOI:
https://doi.org/10.56929/jseaortho-2025-0280Keywords:
fracture, pediatrics, vitamin D deficiency, vitamin D insufficiencyAbstract
Purpose: Vitamin D is essential for bone metabolism. The incidence of pediatric fractures in Thailand is increasing. Although vitamin D deficiency is associated with fracture risk in adults, its association with fracture risk in children remains unclear. This study aimed to compare the mean 25-hydroxyvitamin D [25(OH)D] levels in pediatric patients with and without fractures and to evaluate calcium, phosphate, and parathyroid hormone levels.
Methods: This case-control study included 60 pediatric patients with long bone fractures and 60 patients without fractures in the control group, matched for age, sex, underlying disease, sun exposure, and milk consumption. Patients with fractures were recruited from Vajira Hospital, whereas controls were obtained from a prior database. Patients with high-energy trauma or chronic conditions affecting 25(OH)D levels were excluded. Blood levels of 25(OH)D, calcium, phosphate, and parathyroid hormone were compared between the groups.
Results: Mean 25(OH)D levels were not significantly different between the fracture (23.3 ± 7.0 ng/mL) and nonfracture groups (21.2 ± 6.1 ng/mL) (p = 0.08). Calcium levels were slightly higher in the fracture group (9.6 ± 0.5 mg/dL) than in the nonfracture group (9.4 ± 0.4 mg/dL) (p = 0.04). Phosphate and parathyroid hormone levels were not significantly different between groups.
Conclusions: No significant differences in 25(OH)D levels were observed between children with and without fractures, suggesting that other factors may contribute to fracture risk. Although calcium levels were slightly higher in the fracture group than in the nonfracture group, the difference was not clinically significant.
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References
Naranje SM, Erali RA, Warner WC Jr, et al. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop 2016;36:e45-8.
Kaewpornsawan K, Sukvanich P, Tujinda H, et al. Prevalence and patterns of fractures in children. J Med Assoc Thai 2014;97 Suppl 9:S116-20.
Kopjar B, Wickizer TM. Fractures among children: incidence and impact on daily activities. Inj Prev 1998;4:194-7.
Minkowitz B, Cerame B, Poletick E, et al. Low vitamin D levels are associated with need for surgical correction of pediatric fractures. J Pediatr Orthop 2017;37:23-9.
Clarke NM, Page JE. Vitamin D deficiency: a paediatric orthopaedic perspective. Curr Opin Pediatr 2012;24:46-9.
Contreras JJ, Hiestand B, O'Neill JC, et al. Vitamin D deficiency in children with fractures. Pediatr Emerg Care 2014;30:777-81.
Saglam Y, Kizildag H, Toprak G, et al. Prevalence of vitamin D insufficiency in children with forearm fractures. J Child Orthop 2017;11:180-4.
Gorter EA, Oostdijk W, Felius A, et al. Vitamin D deficiency in pediatric fracture patients: prevalence, risk factors, and vitamin D supplementation. J Clin Res Pediatr Endocrinol 2016;8:445-51.
Okazaki R, Ozono K, Fukumoto S, et al. Assessment criteria for vitamin D deficiency/insufficiency in Japan: proposal by an expert panel supported by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research and the Japan Endocrine Society [opinion]. J Bone Miner Metab 2017;35:1-5.
Paterson CR. Vitamin D deficiency and fractures in childhood. Pediatrics 2011;127:973-4.
Thompson RM, Dean DM, Goldberg S, et al. Vitamin D insufficiency and fracture risk in urban children. J Pediatr Orthop 2017;37:368-73.
Ringe JD. The effect of vitamin D on falls and fractures. Scand J Clin Lab Invest Suppl 2012;243:73-8.
Clark EM. The epidemiology of fractures in otherwise healthy children. Curr Osteoporos Rep 2014;12:272-8.
Fabricant PD, Dy CJ, McLaren SH, et al. Low vitamin D levels in children with fractures: a comparative cohort study. HSS J 2015;11:249-57.
Anderson LN, Heong SW, Chen Y, et al. Vitamin D and fracture risk in early childhood: a case-control study. Am J Epidemiol 2017;185:1255-62.
Kimlin MG. Geographic location and vitamin D synthesis. Mol Aspects Med 2008;29:453-61.
Siwamogsatham O, Ongphiphadhanakul B, Tangpricha V. Vitamin D deficiency in Thailand. J Clin Transl Endocrinol 2015;2:48-9.
Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983;202:1-109.
Knudsen CS, Nexo E, Højskov CS, et al. Analytical validation of the Roche 25-OH vitamin D total assay. Clin Chem Lab Med 2012;50:1965-8.
Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol 2014;144 Pt A:138-45.
Kasemsripitak S, Jaruratanasirikul S, Boonrusmee S, et al. Prevalence and risk factors for vitamin D insufficiency in 6-12-month-old infants: a cross-sectional study in Southern Thailand. BMC Pediatr 2022;22:729.
Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81.
Agar A, Sahin A, Gunes O, et al. Seasonal variation in paediatric orthopaedic trauma Patients - a single centre experience from Turkey. J Orthop Surg (Hong Kong) 2022;30:23094990211068146.
Baker R, Orton E, Tata LJ, et al. Risk factors for long-bone fractures in children up to 5 years of age: a nested case-control study. Arch Dis Child 2015;100:432-7.
Hohoff E, Perrar I, Jancovic N, et al. Age and time trends of dairy intake among children and adolescents of the DONALD study. Eur J Nutr 2021;60:3861-72.
Portale AA. Blood calcium, phosphorus, and magnesium. Primer on the metabolic bone diseases and disorders of mineral metabolism. Philadelphia: Lippincott William and Wilkins;1999.
Soininen S, Eloranta AM, Lindi V, et al. Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study. Br J Nutr 2016;115:1080-91.
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