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Low Vitamin D Tied to Severity of Fractures in Children

Vitamin D deficiency can compromise bone strength and increase susceptibility to severe fracture.

Children with low vitamin D levels are at increased risk for severe forearm fractures that require surgical treatment, according to research presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Fractures in children are common. By some estimates, as many as 50% of boys and 40% of girls have at least one fracture by age 18. The most common site of fracture is the forearm (approximately 25% of all pediatric fractures in the US).

“Not only are forearm fractures common in children, but so is vitamin D deficiency and insufficiency,” said Pooya Hosseinzadeh, MD, assistant professor, Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis. “Knowing that vitamin D deficiency can lead to negative calcium balance, low bone mineral density and quality leading to compromised bone strength, it makes sense for patients to be more susceptible to fractures at lower impact load and more susceptible to greater severity when fractures do occur.”

The study
In this study, 100 children (ages 3 to 15; 65% male) with low-energy forearm fractures were prospectively enrolled. Each participant filled out a questionnaire that focused on risk factors for vitamin D deficiency. The mean 25-hydroxyvitamin D (25[OH]D) concentration was 27.5 + 8.3 ng/mL.

Study results
• 21% of participants were vitamin D deficient (25(OH)D < 20 ng/mL) and 49% had vitamin D insufficiency (25(OH)D: 21 – 29 ng/mL).

• 50% of patients whose fractures required surgery had vitamin D deficiency compared with 17% of those in the non-operative group.

• Vitamin D levels were lower in patients who were overweight/obese or nonwhite.

• 75% of children in the operative group were obese or overweight, compared with only 32% of those in the non-operative group.

• Patients who required operative management were older than 10 years of age and had greater BMI than those who did not require surgery.

The take-home message
“This study provides an important takeaway for parents and pediatricians,” said Dr. Hosseinzadeh. “If a child does have a forearm fracture, we would encourage the physician to check the patient’s vitamin D levels. The good news is that in most cases, children can reduce deficiency with a vitamin D supplement and increasing outdoor activity.”


Hosseinzadeh P, Kiebzak GM. Vitamin D deficiency is associated with increased need for operative treatment of forearm fractures in children. Presented at: 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons; March 6-10, 2018; New Orleans, LA.

Vitamin D deficiency and insufficiency impacts children’s risk for severe forearm fractures [press release]. Rosemont, IL: American Academy of Orthopaedic Surgeons; March 6, 2018.