Kreutzer Adam, McMichael Jessica, Nowicki Philip
Department of Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
Children's Hospital of Orange County, Orange, CA, USA.
J Pediatr Soc North Am. 2024 Apr 9;7:100053. doi: 10.1016/j.jposna.2024.100053. eCollection 2024 May.
Vitamin D insufficiency in pediatric patients is common. Low levels of vitamin D affect bone mineralization, and in growing children, affect bone formation. This effect on overall bone health places children with vitamin D insufficiency and deficiency at risk for low-velocity fractures. Counseling pediatric patients on adequate vitamin D and calcium supplementation can decrease long-term bone health deficits and lead to improved health status as adults. In addition, obesity rates continue to increase in children. Obesity has direct effects on bone metabolism that negatively impact growing skeletons. Refined definitions for obesity will help prevent labeling patients inappropriately as obese but also allow physicians to counsel children and their parents on the long-term risks that obesity plays on both bone health and overall health.
(1)Vitamin D has a strong influence on bone health with low levels of vitamin D being associated with low bone mineralization on DEXA scans.(2)Children with low vitamin D are at risk for low-velocity fractures including the need for surgical intervention for these lower energy injuries.(3)Obesity leads to a chronic inflammatory state that creates a negative overall effect on the growing skeleton.(4)Obesity can be a stigmatizing condition resulting from many factors related to socioecological, environmental, and genetic influences but when appropriately addressed, can lead to improved long-term bone and overall health.
儿科患者维生素D不足很常见。维生素D水平低会影响骨矿化，对于正在成长的儿童，还会影响骨骼形成。这种对整体骨骼健康的影响使维生素D不足和缺乏的儿童面临低速骨折的风险。向儿科患者提供关于充足维生素D和钙补充剂的咨询，可以减少长期的骨骼健康缺陷，并使他们成年后的健康状况得到改善。此外，儿童肥胖率持续上升。肥胖对骨骼代谢有直接影响，会对正在生长的骨骼产生负面影响。对肥胖的精确界定将有助于避免不恰当地给患者贴上肥胖标签，同时也能让医生就肥胖对骨骼健康和整体健康的长期风险向儿童及其家长提供咨询。
（1）维生素D对骨骼健康有很大影响，维生素D水平低与双能X线吸收法扫描显示的低骨矿化有关。（2）维生素D水平低的儿童有低速骨折的风险，包括因这些低能量损伤而需要手术干预。（3）肥胖会导致慢性炎症状态，对正在生长的骨骼产生负面的整体影响。（4）肥胖可能是一种因社会生态、环境和遗传影响等多种因素导致的污名化状况，但如果得到适当处理，可改善长期骨骼健康和整体健康。
