title: Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures.
abstract: BACKGROUND
  There is growing concern over the relationship between the severity of pediatric fractures and low vitamin D [25-hydroxyvitaminD (25(OH)D)] status.
  
  
  OBJECTIVE
  Compare 25(OH)D levels and lifestyle of children with fractures to nonfracture controls to determine if 25(OH)D levels are associated with fractures and if there is a 25(OH)D fragility fracture threshold.
  
  
  METHODS
  Pediatric fracture and nonfracture controls were included. Bone health survey and medical record data were analyzed. Fractures were categorized using the Abbreviated Injury Scale (AIS). AIS 3 fractures were identified as fractures that required surgical intervention. Univariate and multivariable ordinal regression analyses were performed to identify potential risk factors for increased fracture severity.
  
  
  RESULTS
  A total of 369 fracture patients and 662 nonfracture controls aged 18 years and younger were included. Both groups' 25(OH)D levels were comparable. 25(OH)D was 27.5±8.9 in the fracture group compared with 27.4±9.1 ng/mL in nonfracture controls (P=0.914). AIS 3 fractures had lower 25(OH)D levels (24.6±9.3 ng/mL) versus AIS 1 and 2 (30.0±10.8 and 28.3±8.4, respectively, P=0.001). Univariate correlations for AIS severity were found with age (P=0.015) and outdoor playtime (P=0.042). Adjusted odds ratios for 25(OH)D levels <12 ng/mL was 55.4 (P=0.037), 25(OH)D between 12 and 20 ng/mL was 6.7 (P=0.039), 25(OH)D between 20 and 30 ng/mL was 2.8 (P=0.208), and 25(OH)D between 30 and 40 was 1.7 (P=0.518).
  
  
  CONCLUSIONS
  Occurrence of a pediatric fracture was not associated with 25(OH)D levels in our study. However, children with lower vitamin D levels were found to be at higher risk for more severe fractures. Early evidence suggests that the target serum level for 25(OH)D should be at least 40 ng/mL in patients less than 18 years of age as the relative risk of more severe fractures increased as 25(OH)D levels decreased <40 ng/mL.
  
  
  METHODS
  Level III.
authors.affiliation: *Pediatric Orthopedic Surgery †Pediatric Endocrinology, Goryeb Children's Hospital at Atlantic Health System, Morristown, NJ ‡Hospital for Special Surgery, New York, NY.
authors.forename: Barbara
authors.initials: B
authors.lastname: Minkowitz
authors.forename: Barbara
authors.initials: B
authors.lastname: Cerame
authors.forename: Eileen
authors.initials: E
authors.lastname: Poletick
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Formoso
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Luxenberg
authors.forename: Ben H
authors.initials: BH
authors.lastname: Lee
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lane
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D