Low Vitamin D levels are associated with need for surgical correction of pediatric fractures

Barbara Minkowitz, Barbara Cerame, Eileen Poletick, Joseph T. Nguyen, Nicole D. Formoso, Sherri L. Luxenberg, Ben H. Lee, Joseph M. Lane

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)23-29
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2017

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Abbreviated Injury Scale
Vitamin D
Pediatrics
Health Surveys
Medical Records
Life Style
Odds Ratio
Regression Analysis
Bone and Bones
Serum

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Minkowitz, Barbara ; Cerame, Barbara ; Poletick, Eileen ; Nguyen, Joseph T. ; Formoso, Nicole D. ; Luxenberg, Sherri L. ; Lee, Ben H. ; Lane, Joseph M. / Low Vitamin D levels are associated with need for surgical correction of pediatric fractures. In: Journal of Pediatric Orthopaedics. 2017 ; Vol. 37, No. 1. pp. 23-29.
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abstract = "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.",
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Minkowitz, B, Cerame, B, Poletick, E, Nguyen, JT, Formoso, ND, Luxenberg, SL, Lee, BH & Lane, JM 2017, 'Low Vitamin D levels are associated with need for surgical correction of pediatric fractures', Journal of Pediatric Orthopaedics, vol. 37, no. 1, pp. 23-29. https://doi.org/10.1097/BPO.0000000000000587

Low Vitamin D levels are associated with need for surgical correction of pediatric fractures. / Minkowitz, Barbara; Cerame, Barbara; Poletick, Eileen; Nguyen, Joseph T.; Formoso, Nicole D.; Luxenberg, Sherri L.; Lee, Ben H.; Lane, Joseph M.

In: Journal of Pediatric Orthopaedics, Vol. 37, No. 1, 01.01.2017, p. 23-29.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low Vitamin D levels are associated with need for surgical correction of pediatric fractures

AU - Minkowitz, Barbara

AU - Cerame, Barbara

AU - Poletick, Eileen

AU - Nguyen, Joseph T.

AU - Formoso, Nicole D.

AU - Luxenberg, Sherri L.

AU - Lee, Ben H.

AU - Lane, Joseph M.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

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