Thompson Rachel M, Dean Daniel M, Goldberg Sarah, Kwasny Mary J, Langman Craig B, Janicki Joseph A
Departments of *Orthopaedic Surgery ‡Preventive Medicine-Biostatistics, Northwestern University Departments of †Surgery, Division of Orthopaedic Surgery §Medicine, Division of Nephrology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
J Pediatr Orthop. 2017 Sep;37(6):368-373. doi: 10.1097/BPO.0000000000000697.
Investigation into the role of vitamin D in fractures in the pediatric population has been limited despite estimates that as many as 70% of American children have inadequate vitamin D levels (measured as 25-hydroxyvitamin D, 25(OH)D). The purpose of this study was to evaluate vitamin D's role in pediatric fracture risk by comparing 25(OH)D between fractured and nonfractured cohorts.
A 12-month prospective case-control study was completed in children aged 2 to 14 years in an urban, academic hospital. Sixty fractured children requiring conscious sedation or general anesthesia for management were compared with 60 nonfractured controls. All participants and their guardians were surveyed for low bone density risk factors, and total serum 25(OH)D was measured. Statistical analysis was completed using Student t tests, χ tests, analysis of variance, and logistic regression models.
After controlling for age and daily sun exposure, lower total serum 25(OH)D was associated with higher fracture risk (odds ratio=0.94; 95% confidence interval, 0.90-0.99; P=0.023). In the fractured cohort, 6 (10%) patients were deficient (25(OH)D<20 ng/mL) and 33 (55%) were insufficient (25(OH)D, 20 to 30 ng/mL). Of the nonfractured population, 8 (13%) were deficient and 19 (32%) were insufficient. There were more insufficient patients in the fractured than in the nonfractured cohort (odds ratio=2.99; 95% confidence interval, 1.27-7.0; P=0.037).
Higher fracture incidence is associated with serum 25(OH)D insufficiency. Hypovitaminosis D may place the pediatric population at increased risk for fracture. Consideration should be given to routine assessment of vitamin D in fractured children.
Prognostic level III-prospective case-control study.
尽管据估计多达70%的美国儿童维生素D水平不足（以25-羟维生素D，即25(OH)D来衡量），但对维生素D在儿童骨折中作用的研究仍然有限。本研究的目的是通过比较骨折组和非骨折组的25(OH)D水平，评估维生素D在儿童骨折风险中的作用。
在一家城市学术医院对2至14岁的儿童进行了一项为期12个月的前瞻性病例对照研究。将60名因骨折需要清醒镇静或全身麻醉进行治疗的儿童与60名非骨折对照儿童进行比较。对所有参与者及其监护人进行低骨密度风险因素调查，并测量血清总25(OH)D水平。使用学生t检验、χ检验、方差分析和逻辑回归模型进行统计分析。
在控制年龄和每日阳光暴露后，较低的血清总25(OH)D水平与较高的骨折风险相关（比值比=0.94；95%置信区间，0.90-0.99；P=0.023）。在骨折组中，6名（10%）患者维生素D缺乏（25(OH)D<20 ng/mL），33名（55%）患者维生素D不足（25(OH)D为20至30 ng/mL）。在非骨折组中，8名（13%）患者维生素D缺乏，19名（32%）患者维生素D不足。骨折组中维生素D不足的患者比非骨折组更多（比值比=2.99；95%置信区间，1.27-7.0；P=0.037）。
较高的骨折发生率与血清25(OH)D不足有关。维生素D缺乏可能使儿童人群骨折风险增加。应考虑对骨折儿童进行维生素D的常规评估。
预后水平III-前瞻性病例对照研究。
