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Published on: January 29, 2018
Vitamin D status in abused and nonabused children younger than 2 years old with fractures
Samantha Schilling1, Joanne N Wood, Michael A Levine
1The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA. schillings@email.chop.edu
Insights
Vitamin D insufficiency is common in young children with fractures but not linked to abuse. Nonaccidental trauma is the leading cause of multiple fractures in this age group.
Area of Science:
- Pediatrics
- Orthopedics
- Nutritional Science
Background:
- Vitamin D deficiency is a growing concern in pediatric populations.
- Fractures in young children can result from accidental or abusive trauma, necessitating accurate etiological diagnosis.
- Understanding the role of vitamin D in bone health is crucial for fracture management in children.
Purpose of the Study:
- To investigate the prevalence of vitamin D deficiency and insufficiency in children under two years old with fractures.
- To determine if vitamin D status is associated with fracture etiology (abusive vs. accidental), fracture pattern (single vs. multiple), and specific fracture types.
- To explore the relationship between vitamin D levels and biochemical markers of bone health in pediatric fracture patients.
Main Methods:
- A retrospective study was conducted on 118 children under two years of age admitted with fractures to a children's hospital.
- Vitamin D levels and biochemical markers of bone health were analyzed.
- Bivariate analysis and tests for trend were used to assess associations between vitamin D status and fracture characteristics.
Main Results:
- Vitamin D deficiency (<20 ng/mL) was found in 8% of subjects, insufficiency (20-29 ng/mL) in 31%, and sufficiency (≥30 ng/mL) in 61%.
- Lower vitamin D levels correlated with hypocalcemia and elevated alkaline phosphatase.
- No significant association was found between vitamin D levels and child abuse diagnosis, multiple fractures, or specific fracture types like rib or metaphyseal fractures.
Conclusions:
- Vitamin D insufficiency is prevalent in young children with fractures but not disproportionately higher than in healthy children.
- Vitamin D status was not found to be associated with the diagnosis of child abuse or the occurrence of multiple fractures.
- Nonaccidental trauma remains the primary cause of multiple fractures in young children, irrespective of vitamin D levels.
Objective:
To examine vitamin D levels in children with (1) suspected abusive and accidental fractures, (2) single and multiple fractures, and (3) fracture types highly associated with inflicted trauma.
Design And Methods:
A study of children younger than 2 years of age with fractures admitted to a large children's hospital was performed. Bivariate analysis and test for trend were performed to test for the association of vitamin D status and biochemical markers of bone health with the primary outcomes of fracture etiology, number, and type.
Results:
Of 118 subjects in the study, 8% had deficient vitamin D levels (<20 ng/mL; <50 nmol/L), 31% were insufficient (≥20 < 30 ng/mL; ≥50 < 78 nmol/L), and 61% were sufficient (≥30 ng/mL; ≥78 nmol/L). Lower vitamin D levels were associated with higher incidences of hypocalcemia (P = .002) and elevated alkaline phosphatase (P = .05) but not hypophosphatemia (P = .30). The majority of children sustained accidental fractures (60%); 31% were nonaccidental and 9% were indeterminate. There was no association between vitamin D levels and any of the following outcomes: child abuse diagnosis (P = .32), multiple fractures (P = .24), rib fractures (P = .16), or metaphyseal fractures (P = .49).
Conclusions:
Vitamin D insufficiency was common in young children with fractures but was not more common than in previously studied healthy children. Vitamin D insufficiency was not associated with multiple fractures or diagnosis of child abuse. Nonaccidental trauma remains the most common cause of multiple fractures in young children.
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