Low Vitamin D Levels Are Associated With Need For Surgical Correction In Pediatric Fractures

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BACKGROUND: There is growing concern over a relationship between severity of pediatric fractures and low Vitamin D [25-hydroxyvitaminD, 25(OH)D] status. OBJECTIVE: Compare 25(OH)D levels and lifestyle of children with fractures to controls. Determine if 25(OH)D levels are associated with fractures and what the 25(OH)D fragility fracture threshold is within the fracture group. DESIGN/METHODS: Pediatric fracture and community controls were included. Bone health survey and medical record data was analyzed. Univariate and multivariable ordinal regression analyses were performed. Fractures were placed into groups using the Abbreviated Injury Score (AIS). AIS scores get progressively worse starting at AIS 1. AIS 3 were fractures requiring surgery. RESULTS: 369 fracture patients and 662 controls ≤ 18 years were included. Fracture and control groups’ 25(OH)D levels were not statistically different. Fracture group had mean 25(OH)D of 27.5 ± 8.9 vs 27.4 ± 9.1 in controls (p=0.914). However, among fracture patients, those with surgical fracture (AIS 3) had lower 25(OH)D levels (24.6) vs. nonsurgical fractures (AIS 1 & 2 with mean 30.0 and 28.3, respectively, p=0.001). The bone health survey found an association between increased outdoor play time and AIS fracture severity 3 (p=0.042). Adjusted odds ratios (OR) for Vitamin D levels on surgical fracture were calculated. Patients who had 25(OH)D <12 ng/mL were 20 times more likely to have a surgical fracture (OR 21.4, 95% CI 0.9-532, p=0.062). If 25(OH)D was <20ng/mL, the risk of surgical fracture was 3.5 times more likely (OR 3.5, 95% CI: 1.4-9.0, p=0.007). Patients who were <30ng/mL in 25(OH)D levels were twice as likely to have surgical fracture (OR 2.2, 95% CI: 1.0-4.7, p=0.059). Age, sex, and BMI were not found to be significant factors for AIS severity in this study. CLINICAL RELEVANCE: While the occurrence of a pediatric fracture was not associated with 25(OH)D levels in this study, kids with deficient Vitamin D levels appear to be at risk for more severe fractures. Ideal target serum level for 25(OH)D should be least 30ng/mL. Duration of outdoor play appears to be associated with more severe fracture risk. Future studies should investigate if this is due to increased exposure time to more at-risk activities while outdoors.