title: Vitamin D Deficiency: The Missing Etiological Factor in the Development of Juvenile Osteochondrosis Dissecans?
abstract: BACKGROUND
  Vitamin D deficiency can result in rickets and hypocalcemia during infant and childhood growth. There is an increasing interest in the role of vitamin D with regards to childhood bone health. Osteochondrosis dissecans (OD) is a common disease affecting different joints. To date, the exact etiology of OD still remains unclear. The aim of this study was to evaluate a possible association of vitamin D deficiency and juvenile OD.
  
  
  METHODS
  A retrospective chart review of the years 2010 to 2015 of all orthopaedic patients with an initial diagnosis of juvenile OD admitted to undergo operative treatment of the OD was performed. Patient demographics, medical history, information on sports activity (if available) and serum vitamin D (25-OH-D) level on admission date were obtained. For statistical comparison, we measured baseline prevalence of vitamin D insufficiency in age-matched orthopaedic patients presenting at the department of pediatric orthopaedics.
  
  
  RESULTS
  A total of 80 patients were included in this study. Overall, 97.5% (n=78) of tested patients in the OD group had serum vitamin D levels below the recommended threshold of 30 ng/mL (mean value of 10.1 ng/mL (±6.7 ng/mL)). Over 60% (n=49) were vitamin D deficient, 29 patients (37%) showed serum levels below 10 ng/mL corresponding to a severe vitamin D deficiency. Of note, only 2 patients (2.5%) reached serum vitamin D levels above the recommended threshold of 30 ng/mL. No statistical difference was found in respect to sports activity level before onset of the symptoms (P=0.09). Statistical analysis found a significant difference in vitamin D levels between patients with OD and patients without an OD (P=0.026).
  
  
  CONCLUSIONS
  We found an unexpected high prevalence of vitamin D deficiency in juveniles diagnosed with OD presenting with significant lower mean 25-OH-D level compared with a control group. These results suggest that vitamin D deficiency is potentially associated with the development of OD. Thus, vitamin D deficiency might be an important cofactor in the multifactorial development of juvenile OD. For this reason, supplementation of vitamin D might not only be a potential additional therapy but also be a possible preventative factor in patients with juvenile OD. However, future prospective studies are needed to confirm this preliminary data.
  
  
  METHODS
  Level III-this is a case-control study.
authors.affiliation: University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg.
authors.forename: Gerrit S
authors.initials: GS
authors.lastname: Maier
authors.affiliation: University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg.
authors.forename: Djordje
authors.initials: D
authors.lastname: Lazovic
authors.affiliation: University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg.
authors.forename: Uwe
authors.initials: U
authors.lastname: Maus
authors.affiliation: Department of Orthopaedic Surgery, Johannes-Gutenberg-University, Mainz.
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Roth
authors.affiliation: Department of Orthopaedic Surgery, König Ludwig Haus, Julius-Maximilians-University, Würzburg.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Horas
authors.affiliation: Department of Orthopaedic Surgery, Justus-Liebig-University, Gießen, Germany.
authors.forename: Jörn B
authors.initials: JB
authors.lastname: Seeger
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010008:Osteochondritis Dissecans / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood* / Q000150:complications / Q000453:epidemiology*
chemical_list: D014807:Vitamin D