Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures Barbara Minkowitz, MD,* Barbara Cerame, MD,w Eileen Poletick, RN, DNP,* Joseph T. Nguyen, MPH,z Nicole D. Formoso,* Sherri L. Luxenberg, BA,* Ben H. Lee, MD, MPH, MSCR,w Joseph M. Lane, MD,z and Morris-Essex Pediatric Bone Health Group
Background: There is growing concern over the relationship between the 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 nonfracture controls to determine if 25(OH)D levels are associated with fractures and if there is a 25(OH)D fragility fracture threshold. Methods: Pediatric fracture and nonfracture controls were included. Bone health survey and medical record data were analyzed. Fractures were categorized using the Abbreviated Injury Scale (AIS). AIS 3 fractures were identiﬁed as fractures that required surgical intervention. Univariate and multivariable
From the *Pediatric Orthopedic Surgery; wPediatric Endocrinology, Goryeb Children’s Hospital at Atlantic Health System, Morristown, NJ; and zHospital for Special Surgery, New York, NY. J.T.N. was supported in part by funds from the Clinical Transplantational Science Center (CTSC) and the National Center for Advancing Translational Science (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the oﬃcial views of the NCATS based in Rockville, MD. J.M.L. is a consultant for the following: Graftys, Kuros, Bone Therapeutics, and CollPlant. The remaining authors declare no conﬂicts of interest. Morris-Essex Pediatric Bone Health Group: Barbara Minkowitz, MD; Tim U. Leier, MD; Martin L. Cohen, MD; William L. Lupatkin, MD; Suhaib G. Nashi, MD; Tamara McCluskey, DO; Meera Gupta, MD; Maria Gatoulis, MD; Christian Canzoniero, MD; Rajesh Raman, MD; Michael D. Nathan, DO; Zehra Z. Aygen, MD; Kadri M. Aygen, MD; Andrea G. Katz, MD; Susan S. Barasch, MD; Bonita Gillard, MD; Donna Koward, MD; Karen Brandstaedter, MD; Sarah Kramer, MD; Lorin Levin, MD; Andrea Ploshnick, MD; Jeﬀrey Eng, MD; Jessica S. Haines, APN; Nancy Montville, APN; Nicole D. Formoso; Sherri L. Luxenberg; Steven Moskowitz, MD; Kathleen L. Chin, MD; Denise Visci, MD; Eunhee Shih, MD; Richard Lander, MD; Yanina Meshko, MD; Ami Mehta, MD; Hemant Kairam, MD; Teresa Manocchio, DO; Maureen Baxley, MD; Francisco Silva, MD; Sandra R. Voremberg, MD; Jennifer Shaw-Brachfeld, MD; Valerie Tom, MD; Margot Kerrigan, MD; Stuart Slavin, MD; Maria C. Cerdena, MD; John S. Freiheiter, MD; Julio C. Guerra, MD; Ricki L. Gottlieb, MD; Beth Gelman, MD; Elena Shteynberg, MD; Frank A. Sinatra, MD; John Visci, MD; Patricia Peng, DO; Jaclyn Brittman, DO; Marisa Farinella, DO; Lior Fusman; Renee Eng; Jonathan Chevinsky; Samantha Easton; Connor Jordan; Scott Musial. Reprints: Barbara Minkowitz, MD, Pediatric Orthopedic Surgery, Goryeb Children’s Hospital at Atlantic Health System, 100 Madison Avenue, Morristown, NJ 07960. E-mail: [email protected]
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J Pediatr Orthop
Volume 00, Number 00, ’’ 2015
ordinal regression analyses were performed to identify potential risk factors for increased fracture severity. Results: A total of 369 fracture patients and 662 nonfracture controls aged 18 years and younger were included. Both groups’ 25(OH)D levels were comparable. 25(OH)D was 27.5 ± 8.9 in the fracture group compared with 27.4 ± 9.1 ng/mL in nonfracture controls (P = 0.914). AIS 3 fractures had lower 25(OH)D levels (24.6 ± 9.3 ng/mL) versus AIS 1 and 2 (30.0 ± 10.8 and 28.3 ± 8.4, respectively, P = 0.001). Univariate correlations for AIS severity were found with age (P = 0.015) and outdoor playtime (P = 0.042). Adjusted odds ratios for 25(OH)D levels