Pediatric Fractures: Does Vitamin D Play a Role?

作者：Alexa J. Karkenny, Jahn T. Avarello, Regina Hanstein, Yungtai Lo, Ashley Burlage, Rocio Crabb, Kelly McNally, Sara L. Merwin, Jacob F. Schulz, Selina Poon · 发表于：Journal of Pediatric Orthopaedics · 年份：2023 · DOI：10.1097/bpo.0000000000002462 · 被引用次数：5 · 研究领域：Vitamin D Research Studies、Bone fractures and treatments、Bone health and osteoporosis research

BACKGROUND: Vitamin D (25-OHD) deficiency and insufficiency are reported in about half of all children. The literature on low 25-OHD and pediatric fracture risk presents inconsistent results. This study evaluates the association between pediatric fractures and 25-OHD, parathyroid hormone (PTH), and calcium. METHODS: This is a prospective case-control study in 2 urban pediatric emergency departments (2014-2017). Patients aged 1 to 17 requiring intravenous access were enrolled. Demographics, nutrition, and activity information were recorded and levels of 25-OHD, calcium, and PTH were measured. RESULTS: Two hundred forty-five subjects were enrolled: 123 fractures and 122 controls. Overall, the mean 25-OHD level was 23 ng/mL±8.5: 52 (21%) of patients were 25-OHD sufficient; 193 (79%) were not. Ninety-six percent of patients with lower extremity fractures had low 25-OHD versus 77% of patients with upper extremity fractures ( P =0.024). The fracture cohort was younger ( P =0.002), included more males ( P =0.020), and spent more time playing outdoor sports ( P =0.011) than the control cohort. The 25-OHD level (fracture 22.8 ng/mL±7.6 vs. nonfracture 23.5 ng/mL±9.3, P =0.494) and median calcium level (fracture 9.8 mg/dL vs. nonfracture 10.0 mg/dL, P =0.054) were similar between cohorts. The median PTH level was higher in the fracture than the control cohort (33 vs. 24.5 pg/mL; P <0.0005); PTH was elevated to hyperparathyroidism (>65 pg/mL) in 13% of fractures and 2% of controls ( P =...