Pediatric Fractures: Does Vitamin D Play a Role?

Area of Science:

• Pediatric Endocrinology
• Orthopedics
• Nutritional Science

Background:

• Vitamin D (25-OHD) deficiency is prevalent in children, affecting approximately 50%.
• Existing research on the link between low 25-OHD and pediatric fracture risk yields inconsistent findings.
• This study investigates the relationship between pediatric fractures and levels of 25-OHD, parathyroid hormone (PTH), and calcium.

Purpose of the Study:

• To evaluate the association between pediatric fractures and key biochemical markers: 25-OHD, PTH, and calcium.
• To determine if vitamin D status differentiates children with fractures from healthy controls.
• To identify potential biochemical predictors of fracture risk in children.

Main Methods:

• A prospective case-control study was conducted across two urban pediatric emergency departments from 2014 to 2017.
• Participants aged 1-17 requiring intravenous access were enrolled, with data on demographics, nutrition, and activity collected.
• Blood samples were analyzed for 25-OHD, calcium, and PTH levels.

Main Results:

• The study included 123 fracture cases and 122 controls; 79% of all patients had insufficient 25-OHD levels.
• While lower extremity fractures were more common in those with low 25-OHD, overall 25-OHD and calcium levels did not differ significantly between fracture and control groups.
• Children with fractures exhibited significantly higher PTH levels (median 33 vs. 24.5 pg/mL; P <0.0005), with 13% showing hyperparathyroidism compared to 2% in controls.
• Multivariable analysis, adjusted for vitamin D sufficiency and outdoor activity, identified PTH as the sole independent predictor of increased fracture odds (OR=1.10, P=0.021).

Conclusions:

• Low 25-OHD is frequent in pediatric fracture patients, but not significantly different from controls.
• Elevated parathyroid hormone (PTH) levels are independently associated with an increased risk of fractures in children.
• Findings suggest a potential impact on evidence-based guidelines for vitamin D screening and supplementation post-fracture, emphasizing the role of PTH.