The Role of Vitamin D in Pediatric Orthopedics

Vitamin D Supplementation of 7–8 Years Old Children from Different Geographical Areas (48–52° North Latitude): Cross Sectional Study

Background. The prevalence of vitamin D deficiency in children by their geographic latitude of residence requires follow-up study. This is crucial for implementation of preventive measures that can reduce the risk of developing pathological conditions associated with vitamin D deficiency.

Objective. The aim of the study is to study the vitamin D supplementation of 7–8 years old children living in different geographical latitudes of one subject of Russian Federation.

Methods. The study included relatively healthy children living in three geographical areas (northern — 52°, central — 50°, southern — 48°) of one region (Khabarovsk Krai). Vitamin D supplementation was evaluated by 25(OH)D serum concentration via enzyme-linked immunosorbent assay. Vitamin D insufficiency was diagnosed at 25(OH)D concentration of 21–30 ng/ml, deficiency — 10–20 ng/ml, severe deficiency — < 10 ng/ml; optimal 25(OH)D concentration was considered as 30–100 ng/ml.

Results. The increase in prevalence of vitamin D deficiency and insufficiency has been revealed with gradual increase from southern (57%) to central (73%) and northern (83%) geographic areas in 7–8 years old children living in the same region. The prevalence of vitamin D deficiency and insufficiency (25(OH)D ≤ 30 ng/mL) among children living in the northern geographic area was greater by 3.8-fold (95% confidence interval 1.2–12.7) then among peers living in the southern areas.

Conclusion. One factor affecting 25(OH)D serum concentration in children of this region is the insolation level determined by the geographical latitude of residence. The 4°N difference is significant in determining vitamin D status in residents of relatively high latitudes. Further studies of factors associated with 25(OH)D concentration in children living in different latitudes are required (insolation level, number of sunny days per year, food and household characteristics in families).

Substantial decrease in paediatric lower extremity fracture rates in German hospitals in 2017 compared with 2002: an epidemiological study

Background

There are no recent studies on the frequency of paediatric lower extremity fractures in Germany. The aims of this study were to report fracture rates of paediatric lower extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time as well as to evaluate the gender and age distribution for each fracture location.

Methods

Data from the German National Hospital Discharge Registry, which covers over 99% of all German hospitals, were used for this study. The absolute frequencies and incidence of lower extremity fractures as well as age at the time of fracture and gender were included in the data. The population was subdivided into four age groups: 0–4, 5–9, 10–14, and 15–19 years. The boy: girl ratio (BGR) for all fracture locations was calculated by dividing the absolute frequency of boys by that of girls. The fracture incidence in 2017 was compared with 2002 by calculating the incidence rate ratio (IRR).

Results

The total number of fractures decreased by 39.9% from 2002 to 2017. The most common fracture locations in 2002 were femoral shaft, tibial shaft, distal tibia, and lateral and medial malleolus; the absolute number of all these fractures was lower in 2017 than in 2002 in all age groups. The incidence of hip and thigh fractures, knee and lower leg fractures, and foot fractures decreased by 39.0, 41.1, and 33.3%. Proximal tibial fractures increased both in absolute numbers and in incidence in the age groups 0–4, 10–14, and 15–19 years (IRR ≥ 1.1). The overall BGR was 2.3 in 2002 and 2.0 in 2017, indicating that the number of girls relative to that of boys who suffered a lower extremity fracture was higher in 2017 than in 2002. Furthermore, the BGR of all fracture locations increased with age in both years.

Conclusions

The number of paediatric lower extremity fractures treated in German hospitals in 2017 was significantly lower than that in 2002. However, the fracture frequency in girls decreased to a lesser extent than that in boys. The incidence of proximal tibial fractures increased.

High prevalence of vitamin D insufficiency in Chinese children with upper limb fractures

This study aimed at investigating the vitamin D status of pediatric patients with upper limb fractures and finding out the influences of age, gender, season and fracture sites. 695 patients were admitted for upper limb fractures between November 1st 2014 and October 31st 2015. 224 healthy children were included during the same period. Serum 25(OH)D was measured at the time of visit and their demographic data were recorded. Generally fracture patients had significant lower vitamin D level than the healthy children. The average serum 25(OH)D of the patients was 24.5 ng/ml, compared to 28.1 ng/ml in healthy children. Vitamin D status worsened with the increase of age and adolescents had a deficiency rate of as high as 68.6%. Gender and fracture sites had no influence on vitamin D level. This study revealed high prevalence of vitamin D deficiency and insufficiency in pediatric patients with upper limb fractures. Adolescents had such high rate of vitamin D deficiency that called for vast attention.