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Zheng Y, Nour MA, Lanovaz J, Johnston JJD, Kontulainen S. Bone and muscle differences in children and adolescents with type 1 diabetes: The mediating role of physical activity. Bone 2024; 187:117206. [PMID: 39029608 DOI: 10.1016/j.bone.2024.117206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
Children with type 1 diabetes (T1D) experience an increased risk of fracture, which may be related to altered bone development. We aimed to assess differences in bone, muscle and physical activity (PA), and explore if better muscle and PA measures would mitigate bone differences between children and adolescents with T1D and typically developing peers (TDP). We matched 56 children and adolescents with T1D (mean age 11.9 yrs) and 56 TDP (11.5 yrs) by sex and maturity from 171 participants with T1D and 66 TDP (6-17 yrs). We assessed the distal radius and tibia with high-resolution peripheral quantitative computed tomography (HR-pQCT), and the radius and tibia shaft bone and muscle with pQCT. We also measured muscle function from force-related measures in neuromuscular performance tests (push-up, grip test, countermovement and long jump). We compared PA based on questionnaire scores and accelerometers between groups. Bone, muscle, and neuromuscular performance measures were compared using MANOVA. We used mediation to explore the role of PA and muscle in bone differences. Children and adolescents with T1D had 6-10 % lower trabecular density, bone volume fraction, thickness and number at both distal radius and tibia, and 11 % higher trabecular separation at the distal radius than TDP. They also had 3-16 % higher cortical and tissue mineral density, and cortical thickness at the distal radius, 5-7 % higher cortical density and 1-3 % higher muscle density at both shaft sites compared to TDP. PA mediated the between-group difference in trabecular number (indirect effect -0.04) at the distal radius. Children and adolescents with T1D had lower trabecular bone density and deficits in trabecular micro-architecture, but higher cortical bone density and thickness at the radius and tibia compared to TDP. They engaged in less PA but had comparable muscle measures to those of TDP. PA participation may assist in mitigating deficit in trabecular number observed in children and adolescents with T1D.
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Affiliation(s)
- Yuwen Zheng
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
| | - Munier A Nour
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
| | - James J D Johnston
- College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A9, Canada
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada.
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Assaf E, Nicolas G, Hoyek F, Abi Fares G, Lahoud JC, Hajj R, Mohs E, Dally FJ, Hetjens S, Gravius S, Darwich A. Vitamin D level and low-energy fracture risk in children and adolescents: a population-based case-control study of 45 cases. J Pediatr Orthop B 2024; 33:392-398. [PMID: 36756947 DOI: 10.1097/bpb.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The objective of this study is to document the rate of vitamin D deficiency and insufficiency among children with low-energy fractures and compare it to fracture-free control group. We included all children under 15 years presenting to the emergency department with low-energy fractures; controls were children without history of fractures from the outpatient department. Conventional X-ray and laboratory blood tests were performed. Vitamin D deficiency was defined as serum level ≤20 ng/ml, and the mean values were compared through two-sample t -tests. The influence of vitamin D on the fractures was defined using Chi-square test, significance with P -value < 0.05. The relationships between variables and odds of fracture occurrence were examined using logistic regression models. The final sample included 37 cases (30 males, 7 females, 7.4 ± 3.7 years) and 70 control individuals (42 males, 28 females, 7.8 ± 4.6 years) without significant differences regarding age, sex, and month of inclusion. Children with fractures had lower levels of vitamin D (21.87 ± 8.40 ng/ml vs. 25.89 ± 7.62 ng/ml) ( P = 0.01). Vitamin D played a protective role against low-energy fractures (OR, 1.08; 95% CI, 1.01-1.14; P = 0.02), boys showed three times greater fracture risk than girls (OR, 3.00; 95% CI, 1.12-8.07; P = 0.03). Finally, vitamin D deficiency correlated with almost five times increased risk of pediatric low-energy fractures (OR, 4.63; 95% CI, 1.92-11.18; P = 0.001). This is the first MENA study establishing a relation between vitamin D deficiency and low-energy fractures among children and adolescents. The findings show the protective role of vitamin D on the pediatric bone and may help physicians preventing morbidity on children and costs on their families and the socioeconomic health system.
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Affiliation(s)
- Elio Assaf
- Department of Orthopaedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Germany
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Orthopaedic Surgery and Traumatology, Notre Dame des Secours University Hospital Center, Byblos, Lebanon
| | - Georges Nicolas
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Paediatrics
| | - Fadi Hoyek
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Orthopaedic Surgery and Traumatology, Notre Dame des Secours University Hospital Center, Byblos, Lebanon
| | - Georges Abi Fares
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Paediatrics
| | - Jean Claude Lahoud
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Orthopaedic Surgery and Traumatology, Notre Dame des Secours University Hospital Center, Byblos, Lebanon
| | - Rabih Hajj
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Orthopedic Surgery, Bellevue Medical Center, Mansourieh, Lebanon
| | - Elisabeth Mohs
- Department of Orthopaedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Germany
| | - Franz-J Dally
- Department of Orthopaedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Sascha Gravius
- Department of Orthopaedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Germany
| | - Ali Darwich
- Department of Orthopaedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Germany
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Karkenny AJ, Avarello J, Hanstein R, Lo Y, Burlage A, Crabb R, McNally K, Merwin S, Schulz JF, Poon S. Pediatric Fractures: Does Vitamin D Play a Role? J Pediatr Orthop 2023:01241398-990000000-00315. [PMID: 37390504 DOI: 10.1097/bpo.0000000000002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Vitamin D (25-OHD) deficiency and insufficiency are reported in about half of all children. The literature on low 25-OHD and pediatric fracture risk presents inconsistent results. This study evaluates the association between pediatric fractures and 25-OHD, parathyroid hormone (PTH), and calcium. METHODS This is a prospective case-control study in 2 urban pediatric emergency departments (2014-2017). Patients aged 1 to 17 requiring intravenous access were enrolled. Demographics, nutrition, and activity information were recorded and levels of 25-OHD, calcium, and PTH were measured. RESULTS Two hundred forty-five subjects were enrolled: 123 fractures and 122 controls. Overall, the mean 25-OHD level was 23 ng/mL±8.5: 52 (21%) of patients were 25-OHD sufficient; 193 (79%) were not. Ninety-six percent of patients with lower extremity fractures had low 25-OHD versus 77% of patients with upper extremity fractures (P=0.024). The fracture cohort was younger (P=0.002), included more males (P=0.020), and spent more time playing outdoor sports (P=0.011) than the control cohort. The 25-OHD level (fracture 22.8 ng/mL±7.6 vs. nonfracture 23.5 ng/mL±9.3, P=0.494) and median calcium level (fracture 9.8 mg/dL vs. nonfracture 10.0 mg/dL, P=0.054) were similar between cohorts. The median PTH level was higher in the fracture than the control cohort (33 vs. 24.5 pg/mL; P<0.0005); PTH was elevated to hyperparathyroidism (>65 pg/mL) in 13% of fractures and 2% of controls (P=0.006). Matched subgroup analysis of 81 fracture patients and 81 controls by age, gender, and race showed that PTH was the only variable independently associated with increased odds of fracture (odds ratio=1.10, 95% CI, 1.01-1.19, P=0.021) in a model adjusted for vitamin D sufficiency and time spent playing outdoor sports. CONCLUSIONS Low 25-OHD is common in children with fractures but we found no difference in 25-OHD levels between fracture and nonfracture cohorts. This research can impact evidence-based guidelines on vitamin D level screening and/or supplementation after fracture. LEVEL OF EVIDENCE Diagnostic level IV-case-control study.
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Affiliation(s)
| | | | | | - Yungtai Lo
- Albert Einstein College of Medicine, Bronx
| | - Ashley Burlage
- Northwell Health Orthopaedic Institute at Huntington, Huntington
| | - Rocio Crabb
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | | | | | - Selina Poon
- Shriners Hospital for Children, Pasadena, CA
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Herdea A, Ionescu A, Dragomirescu MC, Ulici A. Vitamin D-A Risk Factor for Bone Fractures in Children: A Population-Based Prospective Case-Control Randomized Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3300. [PMID: 36833994 PMCID: PMC9963378 DOI: 10.3390/ijerph20043300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Vitamin D is an essential component in calcium metabolism. Seasonality, advanced age, sex, dark skin pigmentation, and limited exposure to sunlight were reported as causes of vitamin D deficiency. This study aims to determine whether children with lower levels of vitamin D suffer more fractures than those with sufficient levels. MATERIALS AND METHODS Our institution underwent a prospective case-control randomized cross-sectional single-blinded study that included 688 children. They were split into two groups: the study group and the control group. The study group received supplements of vitamin D and calcium for 6 months. Another reference cohort was observed, which comprised 889 patients in the pediatric ward for different respiratory or gastroenterological conditions without a history of fractures. This group was used for age-sex matching tests. RESULTS Logistic regression showed that with every one unit increase of vitamin D level, the chance of having a middle third fracture in both bones of the forearm decreased by 7% (OR 1.07); distal third fracture incidence decreased by 1.03 times; middle third radius fracture incidence decreased by 1.03 times; distal third radius fracture incidence decreased by 1.06 times. The risk of having a distal third both-bone forearm fracture increased by 1.06 times with every year of age. Comparing the healing process, we noticed an improvement in bony callus formation for patients in the study group. CONCLUSIONS Dosing the serum level of 25-OH-vitamin D should be taken into consideration for pediatric low-energy trauma fractures. Supplementing with vitamin D and calcium throughout childhood can be a solution for healthy bones. Our preliminary results show that the normal level of vitamin D in children should start at 40 ng/mL.
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Affiliation(s)
- Alexandru Herdea
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania
- Pediatric Orthopedics Department, “Grigore Alexandrescu” Children’s Emergency Hospital, 011743 Bucharest, Romania
| | - Adelina Ionescu
- Pediatric Orthopedics Department, “Grigore Alexandrescu” Children’s Emergency Hospital, 011743 Bucharest, Romania
| | - Mihai-Codrut Dragomirescu
- Pediatric Orthopedics Department, “Grigore Alexandrescu” Children’s Emergency Hospital, 011743 Bucharest, Romania
| | - Alexandru Ulici
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, 050474 Bucharest, Romania
- Pediatric Orthopedics Department, “Grigore Alexandrescu” Children’s Emergency Hospital, 011743 Bucharest, Romania
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Charoenngam N, Ayoub D, Holick MF. Nutritional rickets and vitamin D deficiency: consequences and strategies for treatment and prevention. Expert Rev Endocrinol Metab 2022; 17:1-14. [PMID: 35852141 DOI: 10.1080/17446651.2022.2099374] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Rickets is typically characterized by bone deformities due to defective bone mineralization and chondrocyte maturation in growing bones. However, infantile rickets often goes unrecognized, because the skeletal abnormalities are more subtle and often can only be detected radiologically. Nutritional rickets is a major public health concern in several regions worldwide. It is most commonly caused by vitamin D and/or calcium deficiency. AREA COVERED We provide an overview of historical perspective, epidemiology, and pathophysiology of nutritional rickets. Additionally, we outline diagnostic approaches and highlight challenges in radiographic diagnosis of rickets. Finally, we present strategies for prevention and treatment of rickets. EXPERT OPINION Despite the evidence from clinical databases that rickets is a rare disease, it is likely that rickets is clinically underdiagnosed as studies designed to screen healthy children for radiographic evidence of rickets reported surprisingly much higher prevalence. It has been reported that some of the radiologic features of rickets can be misinterpreted as fractures. To prevent nutritional rickets, most if not all infants and young children, should receive vitamin D from formulas and foods that are fortified with vitamin D or supplementation to achieve a serum 25-hydroxyvitamin D of at least 20 ng/mL as recommended by the Institute of Medicine. It has been recommended by the Endocrine Society that to achieve maximum bone health for children and adults, a serum concentration of 25-hydroxyvitamin D should be at least 30 ng/mL and preferably 40-60 ng/mL. Pregnant women who are unable to obtain an adequate amount of vitamin D from sunlight exposure and natural and fortified diets should take a vitamin D supplement of 1500-2000 IUs daily as recommended by the Endocrine Society since it has been demonstrated that 600 IUs daily will not maintain a circulating 25-hydroxyvitamin D of at least 20 ng/mL and most pregnant women. If lactating women take approximately 6400 IUs of vitamin D daily, they provide enough vitamin D in their milk to satisfy their infant's requirement thereby preventing rickets.
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Affiliation(s)
- Nipith Charoenngam
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | | | - Michael F Holick
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Vitamin D and Forearm Fractures in Children Preliminary Findings: Risk Factors and Correlation between Low-Energy and High-Energy Fractures. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050762. [PMID: 35626939 PMCID: PMC9139354 DOI: 10.3390/children9050762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022]
Abstract
Background: The forearm is the most common fracture site in childhood, accounting for every fourth pediatric fracture. It is well described that vitamin D is involved in the regulation of bone mineralization and skeletal homeostasis by the regulation of calcium absorption. The aim of our study was to determine the influence of 25-hydroxyvitamin D levels on forearm fracture falls in a pediatric population, depending on level of energy impact. Additionally, we also aimed to evaluate the correlation between 25-hydroxyvitamin D levels and other tested risk factors for pediatric fractures. Methods: We evaluated 50 eligible children aged 3 to 12 years with a forearm fracture. According to energy impact, patients were grouped into low-energy fractures (LEF) and high-energy fractures (HEF) groups. The general characteristics of the patients included age, gender, sport participation, and fractured bone and its localization. We analyzed 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium, phosphate, C-reactive protein (CRP) levels, and body mass index (BMI). Results: There is a significant difference in the 25-hydroxyvitamin D levels distribution between LEF and HEF (p < 0.001) and PTH levels (p = 0.002). For magnesium levels, calcium levels, phosphate levels, and CRP levels, there were no significant differences in their frequency distribution. For the group of patients with LEF, there is a significantly positive correlation between 25-hydroxyvitamin D and calcium levels (p = 0.019) and a borderline significantly positive correlation between 25-hydroxyvitamin D and magnesium levels (p = 0.050). For the group of patients with HEF, there was only a significantly positive correlation between 25-hydroxyvitamin D and PTH levels (p < 0.001). Conclusions: Children with LEF were more frequently insufficient in 25-hydroxyvitamin D levels but had normal calcium levels, compared to the ones with HEF. These findings suggest that LEF and HEF in children might to a certain degree have different pathophysiological mechanisms.
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Mendoza CJP, Ver MLP, Tabberrah AGJ, Ver MR. Association of Pre-Operative Vitamin D Levels and Severity of Fracture among Orthopedic Trauma Patients in A Single, Tertiary-Level Hospital. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211056942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background/Purpose The high prevalence of hypovitaminosis D among trauma patients have been related to risk of fractures, falls, non-union and poor operative outcomes. There is limited evidence that ties up Vitamin D levels with fracture severity. The objective of this study is to determine the association of pre-operative Vitamin D levels and fracture severity. Methods This was a retrospective, cross-sectional study of patients with extremity fractures classified according to the AO Trauma classification system with baseline pre-operative vitamin D levels. The association between vitamin D levels and fracture severity of surgically treated trauma patients were analyzed. Sub-group analysis was performed on patients without osteoporosis and those patients who suffered from low-energy trauma. Results Ninety-six (96) patients were included. Those with severe fractures (AO -C fractures, 31B1.3/B2.3 and 31A3) were associated with lower Vitamin D levels (µ = 17.87 µg/mL) (p < 0.001). There was a strong, positive significant correlation ( rs (4) = .426, p = < 0.001) between hypovitaminosis D and increasing fracture severity. This significant association of hypovitaminosis D with worse fracture patterns remains in the patient sub-group without osteoporosis ( p = 0.030), and in those who sustained low-mechanism injuries ( p < 0.001). Conclusion We present initial evidence that low pre-operative Vitamin D level is associated with increasing fracture severity at the time of injury. Early detection, surveillance and management of low vitamin D levels can lead to drastic changes in the holistic approach to fracture prevention and treatment.
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Affiliation(s)
| | - Mikhail Lew Perez Ver
- Institute of Orthopaedics and Sports Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | | | - Mario Ratio Ver
- Institute of Orthopaedics and Sports Medicine, St. Luke's Medical Center, Quezon City, Philippines
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Örgel M, Zimmer G, Graulich T, Gräff P, Macke C, Krettek C, Winkelmann M, Neunaber C. The impact of lifestyle on forearm fractures in children: A retrospective cohort analysis. Bone 2021; 153:116149. [PMID: 34390887 DOI: 10.1016/j.bone.2021.116149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/31/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Forearm fractures are frequent in children. It is important to identify predisposing factors for increased fracture risk. This retrospective analysis aimed to investigate the correlation between forearm fractures in children and co-factors such as age, TV consumption, consumption of soft drinks, the kind of soft drinks consumed as well as physical activity in daily life and BMI. METHODS This retrospective cohort analysis compared 355 participants at the age of 4 to 12 between 2017 and 2018 with and without forearm fractures in children. It was based on a questionnaire to assess the above-mentioned cofactors regarding behavior and lifestyles choices and aimed to identify whether or not these lead to an increased risk of forearm fractures. For statistical analysis logistic regression was used. RESULTS Logistic regression showed a significant effect on forearm fractures in children for the variables age (Odds ratio 3.3 [95% confidence interval 1.5-7.3], P = .003), TV consumption (Odds ratio 5.4 [95% confidence interval 2.5-22.6], P < .001), consumption of soft drinks (Odds ratio 2.6 [95% confidence interval 1.2-5.6], P = .013), and the kind of soft drinks consumed (Odds ratio 3.1 [95% confidence interval 1.5-6.3], P = .003), [Nagelkerkes-R2 = 0.458; Chi2 = 85.037; df = 6]) with a strong effect according to Cohen (f2 = 0.84). CONCLUSION The study showed a significant correlation between TV and soft drink consumption and increased risk for forearm fractures in children. TV consumption and consumption of soft drinks should be reduced in children to prevent forearm fractures.
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Affiliation(s)
- Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Giulia Zimmer
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Gräff
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcel Winkelmann
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Claudia Neunaber
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Abstract
BACKGROUND This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine. METHODS A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included. RESULTS A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred. CONCLUSIONS Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.
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Affiliation(s)
| | - Susan T Mahan
- Boston Children's Hospital/Harvard Medical School, Boston, MA
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Zheng C, Li H, Rong S, Liu L, Zhen K, Li K. Vitamin D level and fractures in children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab 2021; 39:851-857. [PMID: 34115219 DOI: 10.1007/s00774-021-01238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of the study was to determine the relationship between vitamin D levels and the risk of bone fractures in children and adolescents. MATERIALS AND METHODS PubMed, Embase, and Cochrane library databases were searched using subject and free words. The Newcastle-Ottawa scale form was used to assess literature quality. ReVman 5.2 and Stata 13.0 were used for statistical analyses. The results were expressed as the mean difference (MD)/odds ratio (OR) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I2 and Q tests. Egger's test was used to evaluate publication bias. RESULTS Thirteen studies (3943 participants ≤ 18 years old) were included, and the quality of the literature was acceptable. Regarding the 25-hydroxyvitamin D (25OHD) level in the random effects model, the MD = - 0.12 ng/mL (95% CI: -1.93, 1.69), I2 = 83%, and P < 0.00001, indicating large heterogeneity. Subgroup analyses were conducted according to vitamin D supplementation and 25OHD level, the sources of heterogeneity were not found. Regarding the proportion of subjects with vitamin D deficiency in the random effects model, OR = 1.09 (95% CI: 0.67, 1.79), I2 = 79%, and P < 0.0001. By sensitivity analysis, after removing Al-Daghri's study, OR = 1.22 (95% CI: 0.96, 1.56), I2 = 0%, and P = 0.64. CONCLUSION There is no relationship between vitamin D level and the risk of bone fractures in children and adolescents.
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Affiliation(s)
- Chong Zheng
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Hao Li
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Shuai Rong
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Liantao Liu
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Kepei Zhen
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Kewei Li
- Pediatric Orthopaedics, The Third Hospital of Shijiazhuang, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China.
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11
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Yang KGP, Lam TP, Lee WYW, Hung ALH, Cheng JCY. Association of serum 25OHD levels with risk of paediatric fractures. J Bone Miner Metab 2021; 39:911-912. [PMID: 34435255 DOI: 10.1007/s00774-021-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Kenneth Guang-Pu Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Wayne Yuk-Wai Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alec Lik-Hang Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Affiliation(s)
- Lindsey A Warner
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B158, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel L Sewell
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B158, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nina S Ma
- Bone and Mineral Metabolism Program, Section of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B265, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Yang G, Lee WYW, Hung ALH, Tang MF, Li X, Kong APS, Leung TF, Yung PSH, To KKW, Cheng JCY, Lam TP. Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Osteoporos Int 2021; 32:1287-1300. [PMID: 33704541 DOI: 10.1007/s00198-020-05814-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/30/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED The association between the risk of fractures and suboptimal vitamin D (Vit-D) status remains controversial in children. This meta-analysis suggested that serum 25(OH)Vit-D levels were lower in pediatric cases with fractures. 25-hydroxyvitamin D (25(OH)Vit-D) levels less than 50 nmol/L were associated with increased fracture risk in children. INTRODUCTION This study aimed to assess the association between serum 25(OH)Vit-D and the risk of fractures in children, and to explore the sources of heterogeneity and investigate their impact on results. METHODS Systematic review and meta-analysis were conducted for observational studies comparing serum 25(OH)Vit-D levels between fracture and non-fracture pediatric cases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Analysis on 17 case-control and 6 cross-sectional studies (2929 fracture cases and 5000 controls) suggested that 25(OH)Vit-D was lower in fracture cases than in controls (pooled mean difference (MD) = - 3.51 nmol/L; 95% confidence interval (CI): - 5.60 to - 1.42) with a heterogeneity (I2) of 73.9%. The sensitivity analysis which merged the case-control studies that had a NOS score ≥ 4 showed a pooled MD of - 4.35 nmol/L (95% CI: - 6.64 to - 2.06) with a heterogeneity (I2) of 35.9%. Pooled odds ratio of fracture in subjects with 25(OH)Vit-D ≤ 50 nmol/L compared to subjects with 25(OH)Vit-D > 50 nmol/L was 1.29 (95% CI: 1.10 to 1.53; I2 < 1%). CONCLUSION This study indicated that serum 25(OH)Vit-D levels were lower in pediatric patients with fractures. 25(OH)Vit-D ≤ 50 nmol/L was associated with increased fracture risk in children.
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Affiliation(s)
- G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W Y W Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A L H Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M F Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P S Kong
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P S H Yung
- JC Sports Medicine and Health Sciences Centre, Lui Che Woo Institute of Innovative Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K K W To
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
- Joint Research Laboratory of Promoting Globalization of Traditional Chinese Medicines between Shanghai Institute of Materia Medica, Chinese Academy of Sciences and The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Moore DM, O'Sullivan M, Kiely P, Noel J, O'Toole P, Kennedy J, Moore DP, Kelly P. Vitamin D levels in Irish children with fractures: A prospective case-control study with 5 year follow-up. Surgeon 2021; 20:71-77. [PMID: 33903053 DOI: 10.1016/j.surge.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/14/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Twenty-five-hydroxy-vitamin D3 (25-OH-vit D) is a prohormone that is essential for normal calcium homeostasis and bone metabolism. Understanding its role is an important component of the proper care of the pediatric orthopaedic patient. The aim of this study was to determine whether children in Ireland with fractures have increased prevalence of 25-OH-Vit D deficiency compared with age matched controls and to ascertain the relationship between a low 25-OH-vit D level and the incidence of fractures in Irish children. We hypothesised that children presenting to our centre following a fracture would have significantly lower 25-OH-vit D. METHODS A prospective case-control study at a large urban tertiary referral academic hospital located in Dublin, Ireland was completed over a 14 month period from June 2014 to August 2015. A total of 116 subjects, distributed as cases (n = 58) and controls (n = 58) were included in this study. Whole blood (10 ml) was taken in two serum bottles from each patient. Serum 25-hydroxy-vitamin D3 levels were measured. An age matched control group was generated from other children attending the hospital, who also had vitamin D levels measured for different clinical reasons. We followed up both the fracture and control group for the next 5 years to assess the repeat fracture rate. RESULTS Fifty-eight patients with a fracture requiring operative intervention, were included in the study. Statistical analysis was performed comparing to 58 age and sex-matched controls. The mean vitamin D level for the fracture group was 63.2 nmol/L (SD = 27.3), which was higher than the mean of the controls (62.5 nmol/L) (SD = 21.3) (p = 0.86), but this difference was found not to be statistically significant in unadjusted analysis. There was no statistically significant difference in the number of patients classified with low serum Vitamin D levels (<50 nmolL), with the fracture group consisting of 22 (37.9%) patients, and the control group of 17 patients (29.3%) (p = 0.33) with a level below 50 nmol/L. At five-year follow-up, 11 of the 58 patients (18.9%) in the fracture group went on to have a further fracture compared with eight patients (13.7%) from the control group. Out of these 11 from the fracture group five (45.45%) had been found to have a low serum 25-OH-Vit D level five years previously. Out of the eight controls that presented with a fracture within the five-year period, 3 (37.5%) had had a low vitamin D level at the origin of this study. CONCLUSION The results of this study show that children presenting to our institution with low energy fractures have a prevalence of 38% 25-hydroxy-vitamin D deficiency. This study included children from age 1 to 16 primarily Caucasian encompassing all fracture types resulting from accidental trauma. Our findings suggest that in an Irish pediatric population vitamin D status may impact fracture risk with more than one-third being deficient in this review.
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Affiliation(s)
- Dave M Moore
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - Mike O'Sullivan
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - Pat Kiely
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - Jacques Noel
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - Pat O'Toole
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - Jim Kennedy
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
| | - David P Moore
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland.
| | - Paula Kelly
- Department of Orthopaedics, Children's Hospital Ireland at Crumlin, Dublin, Ireland
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Pazarci Ö, Dogan HO, Kilinc S, Çamurcu Y. Evaluation of Serum Glucagon-Like Peptide 1 and Vitamin D Levels in Elderly Patients with Bone Fractures. Med Princ Pract 2020; 29:219-224. [PMID: 31311025 PMCID: PMC7315181 DOI: 10.1159/000502132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/03/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To evaluate the correlation between levels of serum vitamin D and glucagon-like peptide-1 (GLP-1) in elderly patients with bone fractures. MATERIALS AND METHODS This study included 56 patients and 31 control subjects. The patients included were those aged ≥65 years who were admitted to our hospital with a diagnosis of bone fracture. The control group comprised age-matched, healthy individuals. Levels of serum vitamin D and GLP-1 were measured and compared between the 2 groups. RESULTS Significant differences were noted between the groups in terms of serum levels of vitamin D (p < 0.001) and serum levels of GLP-1 (p < 0.001). A positive correlation was observed between serum levels of vitamin D and GLP-1. CONCLUSION Serum levels of GLP-1 were found to be significantly lower in elderly patients with bone fracture compared to healthy adults. In addition, a significant correlation was found between decreased vitamin D and GLP-1 levels. These results may therefore demonstrate the protective effects of GLP-1 on bone structure and metabolism, similar to those of vitamin D.
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Affiliation(s)
- Özhan Pazarci
- Department of Orthopedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey,
| | - Halef Okan Dogan
- Department of Biochemistry, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Seyran Kilinc
- Department of Orthopedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Yalkin Çamurcu
- Department of Orthopedics and Traumatology, Erzincan University School of Medicine, Erzincan, Turkey
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Chaudhry S. Upper Extremity Care for Children: Unique Medical and Psychosocial Aspects. J Hand Surg Am 2019; 44:606-609. [PMID: 30551917 DOI: 10.1016/j.jhsa.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
Hand surgeons encountering pediatric patients should be attuned to both technical and practical facets of caring for congenital and traumatic pathologies. Psychosocial aspects include engaging children in conversation and factoring in both self and external perception of deformity. Medical considerations are also unique, from including child abuse in the differential to having techniques to assess active motion and sensation in the nonverbal child. Certain universal principles, such as minimizing radiation exposure and limiting needle sticks, have higher emphasis in pediatric patients than in adults. With these aspects in mind, treating children and their families can be a mutually rewarding experience.
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Affiliation(s)
- Sonia Chaudhry
- Department of Pediatric Orthopaedic and Hand Surgery, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT.
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Liu T, Wang E, Li Q, Li L. High prevalence of vitamin D insufficiency in Chinese children with upper limb fractures. Genes Dis 2019; 7:408-413. [PMID: 32884995 PMCID: PMC7452481 DOI: 10.1016/j.gendis.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Tianjing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, China
| | - Qiwei Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, China
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Kiebzak GM, Neal KM. Impact of Race Subgroups on the Assessment of Vitamin D Status in Adolescent Idiopathic Scoliosis. Orthopedics 2019; 42:158-162. [PMID: 31099881 DOI: 10.3928/01477447-20190424-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/15/2019] [Indexed: 02/03/2023]
Abstract
The authors' main objective was to demonstrate the confounding effect of combining subgroup data, specifically race, on the prevalence of vitamin D deficiency in adolescent idiopathic scoliosis (AIS). This was a retrospective chart review. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25[OH]D) less than 20 ng/mL. Data were compared between white patients and black and Hispanic patients. Vitamin D status in girls with AIS was also compared with that in girls without AIS who had a history of fracture and with the medical literature to determine if deficiency in AIS was equal to or greater than other cohorts. Mean age was 13.9±2.3 years for the white girls with AIS (n=221) and 13.6±2.2 years for pooled non-whites (n=134). Significant racial differences were found that biased interpretation of the total pooled cohort. Mean 25(OH)D was 27.9±8.5 ng/mL for white girls with AIS vs 21.9±10.3 ng/mL for non-whites (P<.0001). Deficiency was present in 13.1% of white girls vs 47.8% of non-white girls (P<.0001). Compared with girls with fractures and with the published literature, the race-matched deficiency rates were not abnormally high in girls with AIS. Prevalence of deficiency was greater in non-whites with AIS than in whites. However, percent deficiency was not greater in girls with AIS than in race-matched cohorts without AIS. Without separating data by race, interpretation of vitamin D status can be confounded. [Orthopedics. 2019; 42(3):158-162.].
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Abstract
Understanding the role of vitamin D is an important component of the proper care of the pediatric orthopedic patient. Vitamin D is an essential component of bone metabolism in the growth and development of the pediatric skeleton, which can be acutely affected by changes to the body's vitamin D, calcium, and phosphate levels, resulting in pathologic conditions such as rickets or fractures. This article reviews the main areas in which vitamin D relates to pediatric orthopedics and highlights some of the areas where future research is being directed.
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Affiliation(s)
- Michael P Horan
- Pediatric Orthopaedic Surgery, Palmetto Health-USC Orthopaedic Center, University of South Carolina, 14 Medical Park, Suite 200, Columbia, SC 29203, USA.
| | - Kevin Williams
- Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Medical Park 2, Suite 400, Columbia, SC 29203, USA
| | - Daniel Hughes
- Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Medical Park 2, Suite 400, Columbia, SC 29203, USA
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Randomized phase 2 trial of monthly vitamin D to prevent respiratory complications in children with sickle cell disease. Blood Adv 2019; 2:969-978. [PMID: 29712666 DOI: 10.1182/bloodadvances.2017013979] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/06/2018] [Indexed: 01/30/2023] Open
Abstract
In sickle cell disease, respiratory infection and asthma may lead to respiratory complications that are a leading cause of morbidity and mortality. Vitamin D has anti-infective and immunomodulatory effects that may decrease the risk for respiratory infections, asthma, and acute chest syndrome. We conducted a randomized double-blind active-controlled clinical trial to determine whether monthly oral vitamin D3 can reduce the rate of respiratory events in children with sickle cell disease. Seventy sickle cell subjects, ages 3-20 years, with baseline records of respiratory events over 1 year before randomization, underwent screening. Sixty-two subjects with 25-hydroxyvitamin D levels of 5-60 ng/mL were randomly assigned to oral vitamin D3 (100 000 IU or 12 000 IU, n = 31 each) under observed administration once monthly for 2 years. The primary outcome was the annual rate of respiratory events (respiratory infection, asthma exacerbation, or acute chest syndrome) ascertained by the use of a validated questionnaire administered biweekly. Analysis included 62 children (mean age of 9.9 years, 52% female, and predominantly with homozygous HbS disease [87%]) with mean baseline 25-hydroxyvitamin D of 14.3 ng/mL. The annual rates of respiratory events at baseline and intervention years 1 and 2 were 4.34 ± 0.35, 4.28 ± 0.36, and 1.49 ± 0.37 (high dose) and 3.91 ± 0.35, 3.34 ± 0.37, and 1.54 ± 0.37 (standard dose), respectively. In pediatric patients with sickle cell disease, 2-year monthly oral vitamin D3 was associated with a >50% reduction in the rate of respiratory illness during the second year (P = .0005), with similar decreases associated with high- and standard-dose treatment. This trial was registered at www.clinicaltrials.gov as #NCT01443728.
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An epidemiological evaluation of fractures and its determinants among Lebanese schoolchildren: a cross-sectional study. Arch Osteoporos 2019; 14:9. [PMID: 30643980 DOI: 10.1007/s11657-019-0559-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/03/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study is to establish the prevalence and determinants of fractures among 974 Lebanese schoolchildren aged 8-18. Fractures might be less common in the Lebanese pediatric population compared to western populations. Male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI have no impact. PURPOSE To establish the prevalence of fractures among Lebanese schoolchildren and its relationship with age, gender, BMI, 25 hydroxyvitamin D (25(OH)D) levels, and socioeconomic status (SES). METHODS In this cross-sectional study, 974 Lebanese schoolchildren aged 8-18 years old, mean age 13.37 ± 2.92 (508 boys and 466 girls), were recruited from 10 schools with different SES. For each participant, a questionnaire was used to collect data regarding history of fractures. Serum 25(OH)D was also measured. RESULTS The prevalence of Lebanese children sustaining ≥ 1 fracture was 16.9% and was higher in boys compared to girls (22.2% vs 11.1%, p < 0.0001). A 71.3% of fractures were localized in the upper limbs and 20% of participants had at least one displaced fracture. Children who sustained a fracture had a non-significant higher BMI compared to those without (p = 0.096). The percentage of children with fractures was higher in children from high SES compared to those from middle and low SES (respectively 23.3% vs. 16.3% and 13.8%, p < 0.0001). Fractures occurred at a younger age in girls compared to boys, but this difference was non-significant (p = 0.13). 25(OH)D levels were significantly higher in children with fractures compared to those without (p = 0.017). Finally, female gender was protective against upper limb fractures (p = 0.009). In a logistic regression analysis, male gender and high SES were independently associated with fractures, while BMI and 25(OH)D were not. CONCLUSION Our study demonstrates that the prevalence of fractures in the Lebanese pediatric population might be lower than western populations. It also confirms that male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI were not independently associated with fracture risk.
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Vitamin D levels and fracture risk among Hispanic children. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:531-536. [DOI: 10.1007/s00590-018-2315-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022]
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Salerno G, Ceccarelli M, de Waure C, D'Andrea M, Buonsenso D, Faccia V, Pata D, Valentini P. Epidemiology and risk factors of hypovitaminosis D in a cohort of internationally adopted children: a retrospective study. Ital J Pediatr 2018; 44:86. [PMID: 30053889 PMCID: PMC6062984 DOI: 10.1186/s13052-018-0527-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/18/2018] [Indexed: 01/20/2023] Open
Abstract
Background Predictors of hypovitaminosis D were extensively studied in the adult population, leading to an approximately complete understanding of them, while there is a lack of studies in the pediatric population, especially in migrant and internationally adopted children. In this retrospective study, we tried to identify the major laboratory predictors of hypovitaminosis D in a cohort of internationally adopted children. Methods Data were extracted from the database of the “Ethnopediatrics Outpatient Clinic” of the “A. Gemelli” Foundation University Hospital in Rome, Italy. Our study included 873 children evaluated from March 2007 to May 2016. Analysis of variance, chi square test, t test and multivariate logistic regression were performed, a “p” value < 0.05 was considered significant, with a confidence interval of 95%. Results We did not find any significant correlation between Vitamin D and Calcium, Phosphates or Magnesium levels within the population we examined. Moreover, parathyroid hormone is not a good predictor of Vitamin D Status. Conclusions Considering the strong influence Vitamin D status has not only on bone health, but also on general well-being, it is due to perform a vitamin D assessment as soon as possible, especially in internationally adopted children. Electronic supplementary material The online version of this article (10.1186/s13052-018-0527-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilda Salerno
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Chiara de Waure
- Public Health Institute, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Marianna D'Andrea
- Public Health Institute, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Valerio Faccia
- Department of Gynecologic, Pediatric and Neonatologic Sciences, "Sant'Andrea" University Hospital, Unit of Pediatrics, University "Sapienza" of Rome, Rome, Italy
| | - Davide Pata
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, "A. Gemelli" University Hospital Foundation, Unit of Pediatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
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Bone Health Considerations for the Adolescent Female Athlete. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karpiński M, Popko J, Maresz K, Badmaev V, Stohs SJ. Roles of Vitamins D and K, Nutrition, and Lifestyle in Low-Energy Bone Fractures in Children and Young Adults. J Am Coll Nutr 2018; 36:399-412. [PMID: 28686548 DOI: 10.1080/07315724.2017.1307791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The research on skeletal system health in children and young adults, while recognizing the important role of calcium and vitamin D, goes beyond these nutritional standards. This review focuses on the role of vitamin K in combination with vitamin D and other factors in bone health. The current understanding is that maintaining bone health and prevention of low-energy fractures in any pediatric population includes nutritional factors combined with an active lifestyle. Calcium, vitamin D, and vitamin K supplementation contribute independently and collectively to bone health. The beneficial role of vitamin K, particularly vitamin K2 as menaquinone-7 (MK-7), in bone and cardiovascular health is reasonably well supported scientifically, with several preclinical, epidemiological, and clinical studies published over the last decade. Osteocalcin and matrix-Gla (glutamate-containing) protein (MGP) exemplify vitamin K-dependent proteins involved in building bone matrix and keeping calcium from accumulating in the arterial walls, respectively. An important part of the mechanism of vitamin K involves carboxylation and posttranslational activation of the family of vitamin K-dependent proteins, which prevent expression of pro-inflammatory factors and support improvement in bone mineral concentration, bone mineral density, and the quality of bone matrix. Understanding the combined approach to a healthy skeletal system in children and young adults, including the roles of vitamins D and K, calcium, healthy diet, and exercise, is particularly important in view of reports of subclinical insufficiency of vitamins D and K in otherwise healthy pediatric populations with low-energy bone fractures.
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Affiliation(s)
- Michał Karpiński
- a Department of Pediatric Orthopedics and Traumatology Medical University of Bialystok , Bialystok , Poland
| | - Janusz Popko
- b Medical Institute of the State College of Computer Science and Business Administration , Łomża , Poland
| | | | | | - Sidney J Stohs
- e Creighton University Medical Center , Omaha , Nebraska
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Karpiński M, Galicka A, Milewski R, Popko J, Badmaev V, Stohs SJ. Association between Vitamin D Receptor Polymorphism and Serum Vitamin D Levels in Children with Low-Energy Fractures. J Am Coll Nutr 2017; 36:64-71. [PMID: 28067591 DOI: 10.1080/07315724.2016.1218803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Fractures of bones, especially forearm fractures, are very common in children and their number is increasing. This study was designed to determine the impact of vitamin D serum levels and vitamin D receptor (VDR) polymorphisms on the occurrence of low-energy fractures in children. METHODS The study group consisted of 100 children with clinically relevant bone fractures and a control group consisted of 127 children without fractures. Total vitamin D [25(OH)D3 plus 25(OH)D2] serum concentrations were evaluated in every patient. Genotypes for 4 restriction fragment length polymorphisms of the vitamin D receptor gene (FokI, ApaI, TaqI, and BsmI) were determined by standard polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques. RESULTS Differences in concentrations of vitamin D were observed between the group with bone fractures (median = 12 ng/ml) and the control group (median = 16 ng/ml; p = 0.000044). Higher levels of vitamin D reduced the risk of fracture by 1.06 times (p = 0.0005). No impact of particular VDR polymorphism on the occurrence of low-energy fractures in children was detected. However, there were significant differences in the prevalence of FokI polymorphism genotypes between the fracture and control groups (p = 0.05). Furthermore, the recessive "aa" genotype of ApaI polymorphism and the dominant "TT" genotype of TaqI polymorphism were associated with higher levels of vitamin D (p = 0.005 and p = 0.036, respectively). CONCLUSIONS Vitamin D deficiency is an independent risk factor for fractures in children. ApaI polymorphism recessive "aa" and TaqI polymorphism dominant "TT" genotypes are associated with higher levels of vitamin D in serum.
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Affiliation(s)
- Michal Karpiński
- a Department of Pediatric Orthopedics and Traumatology , Medical University of Bialystok , Białystok , POLAND
| | - Anna Galicka
- b Department of Medical Chemistry , Medical University of Bialystok , Białystok , POLAND
| | - Robert Milewski
- c Department of Statistics and Medical Informatics , Medical University of Bialystok , Białystok , POLAND
| | - Janusz Popko
- a Department of Pediatric Orthopedics and Traumatology , Medical University of Bialystok , Białystok , POLAND
| | | | - Sidney J Stohs
- e School of Pharmacy and Health Professions, Creighton University , Omaha , Nebraska
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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. [PMID: 27651803 PMCID: PMC5019920 DOI: 10.1155/2016/7297092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/28/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To determine the likelihood of vitamin D deficiency and low bone mineral density in Egyptian children with forearm fractures. Methods. A case control study of 46 children aged 3 to 10 years with or without forearm fractures. Validated questionnaires were used to assess calcium and vitamin D intake as well as sun exposure. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy-vitamin D were collected. Bone mineral density was evaluated using dual-energy X-ray absorptiometry. Results. Compared to the Control group, calcium and vitamin D intake was lower in the Cases group (p = 0.03). Cases had higher Body Mass Index than Controls, p = 0.01. Children in the Cases group had lower mean serum calcium values 8.3 ± 1.4 compared to 9.3 ± 1.1 in Controls (p = 0.01). Alkaline phosphatase was higher in Cases 265 ± 65.8 than Controls 226 ± 54.6 (p = 0.03). Vitamin D and bone mineral density scores were significantly lower in the Cases group (p < 0.05). Conclusion. Our data shows an increased rate of vitamin D deficiency and decreased bone mineral density in Egyptian children with forearm fractures.
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Affiliation(s)
- Abeer El-Sakka
- Department of Pediatrics, Ain Shams University Medical School, Cairo, Egypt
| | - Cristina Penon
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA
| | - Adham Hegazy
- Department of Pediatrics, Ain Shams University Medical School, Cairo, Egypt
| | - Salwa Elbatrawy
- Department of Biology, National Research Center, Cairo, Egypt
| | - Amr Gobashy
- Department of Pediatrics, Ain Shams University Medical School, Cairo, Egypt
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA
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