title: Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury.
abstract: BACKGROUND
  The effect of supplemental vitamin D on fracture occurrence following burn injuries is unclear. The objective of this study was to evaluate postintervention incidence of fractures in children during the rehabilitative phase postburn (PB) following participation in a randomized clinical trial of vitamin D supplementation.
  
  
  METHODS
  Follow-up for fracture evaluation was obtained in 39 of 50 patients randomized to daily enteral vitamin D2, D3, or placebo throughout the acute burn course. Serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, D2, D3, calcitonin, and bone alkaline phosphatase (BAP) measurements were obtained PB day 7, midpoint, discharge, and 1-year PB. Urinary calcium was obtained PB day 7 and midpoint. Dual-energy x-ray absorptiometry (DXA) was performed at discharge and 1-year PB.
  
  
  RESULTS
  Fractures were reported in 6 of 39 respondents. Four fractures occurred in the placebo group, 2 in the D2 group, and none in the D3 group. Serum vitamin D, calcitonin, BAP, and urinary calcium were similar between fracture groups. The group with fracture morbidity had larger burn size (83.8% ± 4.9% vs 53.0% ± 2.9%, P < .0001), greater full-thickness burn (69.7% ± 9.4% vs 39.4% ± 4.1%, P = .02), and increased incidence of inhalation injury (33% vs 6%, P = .04). Decreased bone mineral density z score was noted at discharge in the placebo fracture compared with no-fracture group (P < .05).
  
  
  CONCLUSIONS
  This preliminary report suggests there may be benefit of vitamin D3 in reducing postdischarge fracture risk. Results reaffirm the importance of monitoring bone health in pediatric patients postburn.
authors.affiliation: Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio theresa.mayes@cchmc.org.
authors.forename: Theresa
authors.initials: T
authors.lastname: Mayes
authors.affiliation: Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Gottschlich
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.affiliation: Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio Department of Surgery, Shriners Hospitals for Children, Cincinnati, Ohio.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D002056:Burns / Q000453:epidemiology*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D014807:Vitamin D / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D014807:Vitamin D
keywords: bone density; bone fractures; bone health; burns; pediatrics; vitamin D; vitamin D deficiency