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Vitamin D Status and Screening Practices Among Pediatric Fracture Patients With Autism Spectrum Disorder: A
Asahi Murata1, Mayssa Chehab, Rami Rajjoub
1Department of Orthopaedics, Neuro-Orthopaedics Program, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Background:
Vitamin D is essential for pediatric bone health and fracture healing. Children with autism spectrum disorder (ASD) may have risk factors for fracture injuries and vitamin D insufficiency. However, patterns of vitamin D testing and insufficiency among pediatric fracture patients with ASD are not well defined.
Methods:
A single-institution retrospective cohort study of pediatric patients treated for fractures between 2012 and 2024 was conducted. Patients with ASD were compared with an age- and sex-matched cohort without ASD. Chart review identified demographics, comorbidities, medication use, serum 25-hydroxyvitamin D testing, ordering specialty, and supplementation status. Low vitamin D levels were categorized as insufficient and deficient, defined as <30 ng/mL and <20 ng/mL, respectively. Socioeconomic status was assessed using the Area Deprivation Index (ADI) and Childhood Opportunity Index (COI). Cohorts were compared using the χ 2 and Fisher exact tests. Logistic regression was used to identify predictors of vitamin D testing and low vitamin D levels.
Results:
A total of 290 patients (78% male; 145 ASD, 145 non-ASD) were included. Cohorts were similar in age, sex, race/ethnicity, and BMI. Eighty-eight patients (30%) had vitamin D testing, with testing more common among patients with ASD (67 vs. 21, 46% vs. 14%; P <0.001). Low vitamin D was common (46/88, 52%) and did not differ between groups (ASD 36/67, 54% vs. 10/21, 48%; P =0.8). Most testing was ordered by psychiatry, behavioral health, or primary care, while orthopaedic services ordered 4 tests (5%). Multivariable regression identified ASD ( OR =3.7, 95% CI: 1.9-7.6) and atypical antipsychotic use ( OR =7.6, CI: 2.7-25.1) as predictors of testing. Increasing age ( OR =1.2, CI: 1.1-1.4) and worse ADI ( OR =1.3, CI: 1.1-1.6) were predictors of low vitamin D.
Conclusions:
The prevalence of low vitamin D was high among pediatric patients with fractures. Although children with ASD were more frequently tested, the prevalence of low vitamin D was not higher than in children without ASD. Low vitamin D was associated with socioeconomic disadvantage. Screening approaches incorporating socioeconomic risk may complement diagnosis-specific testing practices.
Level Of Evidence:
Level III-retrospective comparative study.
