Serum 25-hydroxyvitamin D levels in children with distal radius torus fractures: A case-control analysis

Vitamin D influences bone mineralization, yet its relationship with distal radius torus fractures in children is uncertain. This study aims to investigate the relationship between serum Vitamin D levels and distal radial torus fracture.

We compared serum 25-hydroxyvitamin D (25[OH]D) levels between children with radiographically confirmed isolated distal radius torus fractures (n=236) and laboratory-tested pediatric outpatient controls (n=505). Controls underwent serum 25(OH) D testing during routine pediatric outpatient health evaluations and were not selected because of fracture, bone pain, suspected metabolic bone disease, or delayed fracture healing. In the fracture cohort, 25(OH)D was measured at the 3rd week after injury dur-ing outpatient follow-up. Group comparisons were performed using the Mann-Whitney U and Chi-square tests. Multivariable logistic regression assessed associations with age and sex. An exploratory subgroup analysis was additionally performed.

Median 25(OH)D was 23.0 (interquartile range [IQR] 16.8-30.3) ng/mL in the fracture patients versus 18.4 (IQR=13.1-26.6) ng/mL in controls (p<0.001). Vitamin D deficiency (<20 ng/mL) occurred of the fracture group and 55.6% of the control group, respectively. After adjustment, 25(OH)D was not independently associated with torus fracture (adjusted OR/10 ng/mL 1.08, 95% CI=0.95-1.23; p=0.262), whereas male sex strongly predicted torus fracture (adjusted OR=3.35, 95% CI=2.41-4.66; p<0.001).

In this laboratory-selected case-control cohort, children with distal radius torus fractures did not have lower measured 25(OH)D levels than outpatient controls. These findings do not support routine Vitamin D testing solely on the basis of an isolated torus fracture, but screening should remain guided by individual clinical risk factors.