Bone Health in Pediatric Fracture Patients: A DEXA Study

Barbara Minkowitz,Eileen Poletick,Leah Nadel,Violet Wallerstein,Jennifer Ristic,Meghan Mcdermott

doi:10.4236/ojo.2022.122007

Abstract

Vitamin D deficiency is widespread in children and is associated with increased fracture severity. Previous studies have shown mixed results on the impact of vitamin D supplementation on bone health parameters measured on dual-energy x-ray absorptiometry (DEXA) scan. This is the first longitudinal DEXA study in a pediatric fracture population. Pediatric fracture patients with vitamin D levels below 20 ng/mL were counseled to take vitamin D and calcium per a serum-based protocol. Patients underwent baseline DEXA within the initial 12 weeks post fracture and had follow-up scans at 6 and 12 months. 48 patients were enrolled, 32 patients completed two DEXA scans, and 19 completed three DEXA scans. There was a significant increase in lumbar spine BMC, TBLH BMD, and TBLH BMC between DEXA 1 and 2 (p 0.001). A positive trend in DEXA parameters is suggested between DEXA 1 and DEXA 3. Height adjusted z-scores (HAZ) were calculated which showed no statistical significance, p-values > 0.05. In this group, there are no significant changes in TBLH, BMC or BMD z-scores one year after fracturing despite vitamin D and calcium supplementation. This suggests that children returning to collision sports may be at continued risk for refracture and future studies are needed.

Highlights

There are no significant changes in TBLH, bone mineral content (BMC) or bone mineral density (BMD) z-scores one year after fracturing despite vitamin D and calcium supplementation
This study aims to study the effects of providing supplemental vitamin D and calcium on total BMC and BMD at 6 months and 12 months in pediatric fracture patients
There was a significant increase seen in lumbar spine BMC, TBLH BMD, and TBLH BMC between dual-energy x-ray absorptiometry (DEXA) 1 and 2 (p < 0.001, Table 2)

Summary

Introduction

Vitamin D is an important nutrient that impacts skeletal development by controlling levels of parathyroid hormone (PTH) and increasing calcium absorption. Vitamin D is primarily obtained from the sun, but 5% is from dietary intake [3]. Vitamin D deficiency is especially widespread in the winter. Even in areas with year-round sun, most children are found to have low vitamin D levels [4] [5]. In a survey of vitamin D levels in children in the US, 70% of the population was found to be either deficient or insufficient regardless of season (Vitamin D level less than 30 ng/mL serum 25(OH)D) [6]

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