Frequency of Vitamin D Deficiency in Pediatric Fractures Presenting to A Tertiary Care Hospital
Keywords:Vitamin D, Vitamin D deficiency, Pediatric fractures, Serum 25(OH)D
Introduction: Majority of childhood fractures occur due to high impact trauma and immediate fracture management is crucial for future healing process. While treating fractures in children it is often a missed opportunity to assess osteopenia risk factors such as poor calcium intake, vitamin D de?ciency, and sedentary life style. However, many fractures are related to bad bone health. This study aims to estimate the burden of vitamin D deficiency (VDD) in pediatric population with fracture, so that timely intervention and strategy to replace vitamin D can be taken.Methods: This study was conducted at Department of Orthopedic and Accident and Emergency Department, Jinnah postgraduate medical center, Karachi, from July 2019 to June 2020. Three hundred and forty five pediatric patients with fracture confirmed by X-ray were included to observe the vitamin D deficiency. Blood sample was taken from the accessible peripheral vein in vacutainer without additives. Serum 25(OH) D was measured and all the information were recorded in predesigned proforma.
Results: The average age of the children was 9.10±3.76 years317 (91.88%) were boys and 28 (8.12%) girls. Frequency of vitamin D deficiency in pediatric fractures was observed in 34.20% (118/345). Rate of VDD was significantly high in those children whose BMI was less and equal to 20 kg/m2. Duration of fracture, cause of fracture and traumatic cause were also stratified for VDD but insignificant difference was observed.
Conclusion: The results of this study concluded that, vitamin D deficiency in pediatric population presenting with bone fractures is very high. Physicians who treat such children should take proper dietary history and notify the patient and their parents about the high level of prevailing vitamin D deficiency. The clinician should also advice regarding vitamin D supplementation and also notes the presence of potential risk factors. Vitamin D measurement and appropriate replacement can be considered in children who present with a fracture.
Wolfe JA, Wolfe H, Banaag A, Tintle S, Perez Koehlmoos T. Early Pediatric Fractures in a Universally Insured Population within the United States. BMC Pediatr. 2019;19(1):343.
Gorter EA, Oostdijk W, Felius A, Krijnen P, Schipper IB. Vitamin D Deficiency in Pediatric Fracture Patients: Prevalence, Risk Factors, and Vitamin D Supplementation. J Clin Res Pediatr Endocrinol. 2016;8(4):445-451.
Oleck NC, Dobitsch AA, Liu FC, et al. Traumatic Falls in the Pediatric Population: Facial Fracture Patterns Observed in a Leading Cause of Childhood Injury. Ann Plast Surg. 2019;82(4S Suppl 3):S195-S198.
El-Sakka A, Penon C, Hegazy A, Elbatrawy S, Gobashy A, Moreira A. Evaluating Bone Health in Egyptian Children with Forearm Fractures: A Case Control Study. Int J Pediatr. 2016;2016:7297092.
Mansoor K, Shahnawaz S, Ahmad A, Arif MM, Hamza M. Epidemiology of childhood fractures in the city of Karachi. J Ayub Med Coll Abbottabad. 2015;27(3):608-612.
Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother. 2012;3(2):118-126.
Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, et al. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr. 2013;56(6):692-701.
Contreras JJ, Hiestand B, O’Neill JC, Schwartz R, Nadkarni M. Vitamin D deficiency in children with fractures. Pediatr Emerg Care. 2014;30(11):777-81.
9. Minkowitz B, Cerame B, Poletick E, Nguyen JT, Formoso ND, Luxenberg SL. Low vitamin D levels are associated with need for surgical correction of pediatric fractures. J Pediatr Orthop. 2017;37(1):23-29.
Keller KA, Barnes PD. Rickets vs abuse: a national and international epidemic. Pediatr Radiol. 2008;38(11):1210–6.
Clarke, NM., Page, JE. Vitamin D de?ciency: a paediatric orthopaedic perspective. Curr Opin Pediatr. 2012;24(1):46–49.
12.Riaz H, Finlayson AE, Bashir S, et al. Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol. 2016;9(2):329-338.
van As AB, Lutz T F, Millar AJW, Rode H. Clinicaland Laboratory Parameters with Prognostic Value in Paediatric Traumatic Shock. Afr J Trauma. 2003;1:24-28.
Nwadinigwe CU, Akwuba A. Limb amputation in children: Major risk factors in our environment. Nigerian J Orthopaedics Trauma. 2002;1(2):112-116.
Clarke NM, Page JE. Vitamin D deficiency: a paediatric orthopaedic perspective. Curr Opin Pediatr. 2012;24:46–49.
Baig A, Anjum P, Khani MK, Islam N, Rahman A. Pattern of serum Vitamin D in OPD patients. Pak J Surg. 2007;23:145-149.
Masud F. Vitamin D levels for optimum bone health. Singapore Med J. 2007;48:207-212.
Barlas K, Baga T. Medial approach for fixation of displaced supracondylar fractures of the humerus in children. Acta Orthop Bel. 2005;71:149-153.
Adesunkanmi AR, Oginni LM, Oyelami OA, Badru OS. Road Traffic Accidents to African Children: assessment of severity using the Injury Severity Score. Injury. 2000;31:225-228.
Bedoya MA, Barrera CA, Bencardino JT, Ho-Fung V. Humeral lesser tuberosity avulsion fractures—magnetic resonance imaging characteristics in the pediatric population. Pediatric Radiology. 2021 Jul;51:1421-30.
Khan MA, Khan SW, Qadir RA. Role of External Fixator in the management of type-II & III open tibial fracture. J Postgrad Med Inst. 2004;18:7-12.
Nwomeh BC, Ameh EA. Paediatric Traumain Africa. Afr J Trauma. 2003;1:7-13.
Adeyemi- Doro HO. Trendsin Trauma Carein Nigeria. Afr J Trauma. 2003;1:35-8.
Tahir A, Hassan AW. An Analysis of Fracture Patternin Children at the University of Maiduguri Teaching Hospital. Niger J Med. 1998;7(3):109-111.
Ryan LM, Brandoli C, Freishtat RJ, Wright JL, Tosi L, Chamberlain JM. Prevalence of vitamin D insufficiency in African American children with forearm fractures: a preliminary study. J Pediatr Orthop. 2010;30(2):106-109.
Goulding A, Cannan R, Williams SM, Gold EJ, Taylor RW, Lewis-Barned NJ. Bone mineral density in girls with forearm fractures. J Bone Miner Res. 1998;13(1):143-148.
Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, El-Kholie E, Yousef M, et al. Increased vitamin D supplementation recommended during summer season in the gulf region: a counterintuitive seasonal effect in vitamin D levels in adult, overweight and obese Middle Eastern residents. Clin Endocrinol (Oxf). 2012;76(3):346-350.