Maier Gerrit S, Lazovic Djordje, Maus Uwe, Roth Klaus E, Horas Konstantin, Seeger Jörn B
University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg.
Department of Orthopaedic Surgery, Johannes-Gutenberg-University, Mainz.
J Pediatr Orthop. 2019 Jan;39(1):51-54. doi: 10.1097/BPO.0000000000000921.
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.
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.
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).
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.
Level III-this is a case-control study.
维生素D缺乏可导致婴幼儿及儿童生长期间出现佝偻病和低钙血症。维生素D在儿童骨骼健康方面的作用越来越受到关注。剥脱性骨软骨炎（OD）是一种影响不同关节的常见疾病。迄今为止，OD的确切病因仍不清楚。本研究的目的是评估维生素D缺乏与青少年OD之间可能存在的关联。
对2010年至2015年所有因初次诊断为青少年OD而入院接受OD手术治疗的骨科患者进行回顾性病历审查。获取患者的人口统计学信息、病史、体育活动信息（若有）以及入院当天的血清维生素D（血清25-羟维生素D）水平。为进行统计学比较，我们测量了在小儿骨科就诊的年龄匹配的骨科患者中维生素D不足的基线患病率。
本研究共纳入80例患者。总体而言，OD组中97.5%（n = 78）的受试患者血清维生素D水平低于推荐阈值30 ng/mL（平均值为10.1 ng/mL（±6.7 ng/mL））。超过60%（n = 49）的患者维生素D缺乏，29例患者（37%）血清水平低于10 ng/mL，属于严重维生素D缺乏。值得注意的是，只有2例患者（2.5%）血清维生素D水平高于推荐阈值30 ng/mL。在症状出现前的体育活动水平方面未发现统计学差异（P = 0.09）。统计学分析发现，OD患者与非OD患者的维生素D水平存在显著差异（P = 0.026）。
我们发现，与对照组相比，被诊断为OD的青少年中维生素D缺乏的患病率意外地高，其血清25-羟维生素D平均水平显著更低。这些结果表明，维生素D缺乏可能与OD的发生有关。因此，维生素D缺乏可能是青少年OD多因素发病过程中的一个重要辅助因素。出于这个原因，补充维生素D可能不仅是一种潜在的辅助治疗方法，而且可能是青少年OD患者的一个预防因素。然而，需要未来的前瞻性研究来证实这些初步数据。
三级——这是一项病例对照研究。
