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Published on: August 14, 2018
Rachitic change and vitamin D status in young children with fractures
Sabah Servaes1, Lisa States2, Joanne Wood3
1Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA. servaes@email.chop.edu.
Insights
Fractured infants and toddlers often have low vitamin D levels. However, visible signs of rickets on X-rays are rare in this age group, despite frequent fractures.
Area of Science:
- Pediatric Radiology
- Nutritional Rickets
- Pediatric Orthopedics
Background:
- Vitamin D deficiency is a growing concern in pediatric populations.
- Fractures in young children can be indicative of underlying metabolic bone disease.
- Rickets, a condition caused by vitamin D deficiency, affects bone development.
Purpose of the Study:
- To investigate the relationship between vitamin D levels and radiographic signs of rickets in children under two years old who have sustained fractures.
- To determine the prevalence of specific rachitic changes in this pediatric cohort.
Main Methods:
- A retrospective review of skeletal surveys from 79 children under two years old with fractures was conducted.
- Two pediatric radiologists independently assessed skeletal surveys for signs of rickets, including demineralization, widened sutures, Looser zones, and metaphyseal changes.
- Logistic regression analysis was used to correlate vitamin D levels with observed rachitic findings, adjusting for covariates.
Main Results:
- Twenty-seven out of 79 subjects had low vitamin D levels.
- Lower vitamin D levels were significantly associated with increased odds of demineralization (P < 0.015).
- No significant association was found between vitamin D levels and widened sutures (P = 0.07). Looser zones, rachitic rosary, and metaphyseal changes were not observed.
Conclusions:
- Infants and toddlers presenting with fractures commonly exhibit suboptimal vitamin D levels.
- Radiographic evidence of rickets is infrequent in young children with fractures, even with low vitamin D levels.
Objective:
To examine the association between rachitic changes and vitamin D levels in children less than 2 years old with fractures.
Methods:
Children less than 2 years old who were admitted to a large children's hospital for a fracture and underwent a skeletal survey were included. Two pediatric radiologists blinded to the children's vitamin D levels independently reviewed the skeletal surveys for the following rachitic findings: demineralization, widened sutures, rachitic rosary, Looser zones, and metaphyseal changes. Kappa coefficients were calculated to assess inter-rater agreement. Logistic regression was used to test the association between vitamin D level and rachitic findings.
Results:
There were 79 subjects (40 female and 39 male) with a median age of 4 months. Vitamin D levels ranged from 11.6 to 88.9 ng/ml and were low in 27. Questionable demineralization was noted in seven subjects; mild to moderate demineralization was observed in four subjects. Widened sutures were noted in seven subjects, many also with concurrent intracranial hemorrhage. Lower vitamin D levels were associated with increased odds of demineralization after adjusting for age, gender, and prematurity (P < 0.015). An association was not found between the vitamin D level and suture widening (P = 0.07). None of the cases demonstrated Looser zones, rachitic rosary, or metaphyseal changes of rickets.
Conclusions:
Infants and toddlers with fractures frequently have suboptimal vitamin D levels, but radiographic evidence of rickets is uncommon in these children.
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