title: Vitamin D Deficiency in Children Undergoing Vertical Expandable Prosthetic Titanium Rib Treatment.
abstract: BACKGROUND
  Vitamin D deficiency is prevalent in the pediatric population and multiple risk factors have been identified. Low vitamin D levels can result in poor bone mineralization and have been associated with a significantly higher risk of forearm fracture in children. Vitamin D deficiency has also been associated with pediatric critical illness. The purpose of this study was to determine whether children undergoing vertical expandable prosthetic titanium rib (VEPTR) treatment have low vitamin D levels.
  
  
  METHODS
  Patients undergoing VEPTR treatment at a single institution were prospectively enrolled (VEPTR). All patients either had a diagnosis of thoracic insufficiency syndrome (TIS), or were at risk of developing TIS secondary to progressive scoliosis or chest wall deformity. Exclusion criteria were patients with rickets and patients receiving vitamin D supplementation at the time of VEPTR insertion. A group of healthy children who presented with fractures during the winter season were used as controls (FX). Vitamin D status and risk factors for vitamin D deficiency were evaluated. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OH-D) <20 ng/mL and vitamin D insufficiency as serum 25-OH-D between 20 and 29 ng/mL.
  
  
  RESULTS
  Twenty-eight VEPTR and 25 FX patients were compared. The average age was 8.6 years in the VEPTR group and 9.1 years in the FX group. Twenty VEPTR patients (71%) and 19 FX patients (76%) demonstrated low vitamin D levels. The average 25-OH-D level was 27.3 ng/mL in the VEPTR group and 25.4 ng/mL in the FX group. Patient characteristics and vitamin D levels were similar between the groups. No association was found between vitamin D status and sex, race, obesity, or multivitamin use.
  
  
  CONCLUSIONS
  Low vitamin D levels are common in children undergoing VEPTR treatment. In our series, the prevalence of vitamin D deficiency in this patient population was similar to reported rates in the general pediatric population. Vitamin D status should be routinely monitored in children undergoing VEPTR treatment and supplementation should be initiated if necessary.
authors.affiliation: Departments of *Orthopaedic Surgery §Statistics ∥Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI †Department of Orthopaedic Surgery, Children's Hospital of The King's Daughters, Norfolk, VA ‡Department of Orthopaedic Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Nahbee
authors.initials: N
authors.lastname: Jong
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Caird
authors.forename: Allison
authors.initials: A
authors.lastname: Tenfelde
authors.forename: Philip
authors.initials: P
authors.lastname: Nowicki
authors.forename: Kerby
authors.initials: K
authors.lastname: Shedden
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Nelson
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D012272:Ribs / Q000601:surgery*; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications*; D013577:Syndrome; D013896:Thoracic Diseases / Q000209:etiology / Q000601:surgery; D014025:Titanium; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D014025:Titanium