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Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury
Theresa Mayes1, Michele M Gottschlich2, Jane Khoury3
1Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio theresa.mayes@cchmc.org.
Insights
Vitamin D3 supplementation may reduce fracture risk in pediatric burn patients. Monitoring bone health is crucial during rehabilitation after severe burns.
Area of Science:
- Pediatric burn rehabilitation
- Nutritional supplementation
- Bone health monitoring
Background:
- The impact of vitamin D on fracture risk post-burn injury is not well-established.
- Pediatric burn patients face potential bone health complications during recovery.
Purpose of the Study:
- To assess the incidence of fractures in children during burn rehabilitation.
- To evaluate the effect of vitamin D supplementation (D2, D3, or placebo) on fracture occurrence.
Main Methods:
- Randomized clinical trial involving 50 pediatric burn patients.
- Supplementation with enteral vitamin D2, D3, or placebo during acute burn care.
- Fracture evaluation, serum vitamin D levels, bone metabolism markers, and DXA scans were performed.
Main Results:
- Fractures occurred in 6 of 39 patients: 4 in placebo, 2 in D2, and 0 in D3 groups.
- Patients with fractures had larger burn size, greater full-thickness burns, and higher incidence of inhalation injury.
- Lower bone mineral density z-scores were observed at discharge in the placebo fracture group.
Conclusions:
- Preliminary findings suggest vitamin D3 may decrease post-discharge fracture risk in pediatric burn survivors.
- This study highlights the importance of assessing and monitoring bone health in pediatric patients after burn injuries.
Background:
The effect of supplemental vitamin D on fracture occurrence following burn injuries is unclear. The objective of this study was to evaluate postintervention incidence of fractures in children during the rehabilitative phase postburn (PB) following participation in a randomized clinical trial of vitamin D supplementation.
Materials And Methods:
Follow-up for fracture evaluation was obtained in 39 of 50 patients randomized to daily enteral vitamin D2, D3, or placebo throughout the acute burn course. Serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, D2, D3, calcitonin, and bone alkaline phosphatase (BAP) measurements were obtained PB day 7, midpoint, discharge, and 1-year PB. Urinary calcium was obtained PB day 7 and midpoint. Dual-energy x-ray absorptiometry (DXA) was performed at discharge and 1-year PB.
Results:
Fractures were reported in 6 of 39 respondents. Four fractures occurred in the placebo group, 2 in the D2 group, and none in the D3 group. Serum vitamin D, calcitonin, BAP, and urinary calcium were similar between fracture groups. The group with fracture morbidity had larger burn size (83.8% ± 4.9% vs 53.0% ± 2.9%, P < .0001), greater full-thickness burn (69.7% ± 9.4% vs 39.4% ± 4.1%, P = .02), and increased incidence of inhalation injury (33% vs 6%, P = .04). Decreased bone mineral density z score was noted at discharge in the placebo fracture compared with no-fracture group (P < .05).
Conclusion:
This preliminary report suggests there may be benefit of vitamin D3 in reducing postdischarge fracture risk. Results reaffirm the importance of monitoring bone health in pediatric patients postburn.
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