Vitamin D sufficiency screening in preoperative pediatric orthopaedic patients

Vitamin D is a critical factor in bone metabolism. Vitamin D levels in both children and adults have been reevaluated to assess standards for sufficiency and deficiency. In the adult population, the currently recommended level for Vitamin D sufficiency is greater than 32 ng/mL measured by 25-hydroxyvitamin D assay. Recommended levels for growing children have not been definitively determined; however, scales based on available literature have been used. The purpose of this study was to evaluate Vitamin D sufficiency in pediatric orthopaedic patients admitted to the hospital for surgical procedures which require bone healing.

Serum 25 hydroxyvitamin D (25 OHD) levels measured by immunochemoluminometric assay were obtained on consecutive pediatric orthopaedic patients admitted electively for long bone osteotomies or spinal fusions over a 10-month period. Seventy patients ranging in age from 2 to 19 years were screened for Vitamin D sufficiency. Vitamin D levels were examined for correlation with age, sex, ethnicity, body mass index (BMI), BMI percentile, orthopaedic diagnosis, and season.

Total 90% of the screened patients had 25 OH vitamin D levels below 32 ng/mL. African American children were more likely to have severe Vitamin D deficiency (P=0.013). Vitamin D levels were lower in the winter months (P=0.046). When 20 ng/mL was used as a cutoff, the average age of children below this cutoff was higher than those above (P=0.018). There was no correlation of Vitamin D levels with sex, BMI, BMI percentile, residence in Mexico, and diagnosis.

Total 90% of the children in the screening group were at risk for poor bone healing owing to Vitamin D deficiency or insufficiency. African American children, in particular, should be evaluated for Vitamin D sufficiency before orthopaedic surgeries. Further work must be done to determine the impact of Vitamin D insufficiency on surgical outcomes.

Diagnostic study, III.