Vitamin D deficiency in children: 9%, but up to 75% in children with fractures – April 2024

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Vitamin D and Pediatric Bone Health – Important Information and Considerations for the Pediatric Orthopaedic Surgeon

Journal of the Pediatric Orthopaedic Society of North America https://doi.org/10.1016/j.jposna.2024.100042
Fatima Bouftas a, Clarabelle DeVries b

Highlights

• Vitamin D plays a vital role in musculoskeletal health and optimizing vitamin D levels in childhood and adolescence is crucial to proper bone development.
• Vitamin D deficiency and insufficiency in the general population is common; 9% of the pediatric population, representing 7.6 million US children and adolescents, are vitamin D deficient and 61%, representing 50.8 million US children and adolescents, are vitamin D insufficient. The prevalence of vitamin D deficiency in the pediatric fracture population can be as high as 75%.
• Vitamin D deficiency can lead to nutritional rickets which is the most frequent cause of pediatric bone disease in the world, is entirely preventable, and is characterized by deficient mineralization and subsequent architectural disruption of the physis.
• Vitamin D supplementation is widely recommended and believed to be beneficial, but there are inconsistent guidelines regarding target levels for optimal vitamin D status.

Vitamin D is an essential fat-soluble vitamin produced in the skin during sun exposure. It plays a considerable role in musculoskeletal health and is largely responsible for the regulation of calcium and phosphate metabolism to maintain a healthy, mineralized skeleton. Optimizing bone mineral density in childhood and adolescence is essential to the foundation of skeletal health; however, the literature lacks consensus on values for normal, deficient, and insufficient serum 25-hydroxyvitamin D levels making supplementation and treatment somewhat challenging.

The pediatric orthopaedic surgeon is important to optimizing bone health, particular in the context of bony pathology/injury. Up to 60% of boys and 40% of girls sustain a fracture in childhood. On top of this baseline incidence, children with low vitamin D levels have been noted to be subject to a higher incidence of fractures from normal activities. While the prevalence of vitamin D deficiency in children in the general population has been determined to be 9%, the prevalence of vitamin D deficiency in the pediatric fracture population can be as high as 75% and 61% of the pediatric population has been determined to have vitamin D insufficiency. The pediatric orthopaedist also often is the first to diagnose nutritional rickets as these patients can present solely for complaints of limb deformity. Knowledge of appropriate evaluation, vitamin D supplementation, and indications for pediatric endocrinology referral is vital for treatment of these patients.

In the pediatric population, there is a lack of consensus regarding risk factors that warrant screening for vitamin D deficit, determining insufficient thresholds, and identifying optimal supplementation recommendations and treatment dosages. More research is needed to clarify ideal amounts of vitamin D necessary through critical growth periods to prevent rickets and to mitigate fracture risk. Regardless, pediatric orthopaedic surgeons should promote supplementation to all children and treat diagnosed vitamin D deficiency.

Clipped from PDF
"There is evidence that about 66% of all pediatric fractures occur in children who fracture on more than one occasion,...

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Vitamin D Life – Falls and Fractures category:

• 254 items in FALLS and FRACTURES
• Vitamin D and Calcium cost-effectively reduce falls and fractures – April 2019
• see also Overview Seniors and Vitamin D
  • Overview Fractures and Falls and Vitamin D
  • Overview Fractures and vitamin D
  • Overview Muscles and Vitamin D

Falls

• Fall prevention - Vitamin D is one of the ways - umbrella review Jan 2024
• Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
• Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
• Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
• Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
  • Note: It took 6 months to get to that level. Most trials last only 3 months
• Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
• Falls reduced by Vitamin D: 13 percent reduction if more than 700 IU – review of 38 trials – Aug 2022

Fracture

• Hip fractures are predicted by 10 factors – low Vitamin D is the biggest – Aug 2023
• Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
• Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
• Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
• 75+ Hip fracture items in Vitamin D Life title   Click here for details

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Vitamin D Life - 12 studies in both categories Falls & Fractures and Infant-Child

This list is automatically updated

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You can test your child for extreme Vitamin D deficiency in 20 seconds

Quick, free, self test of vitamin D deficiency has
You basically want to see if some of your bones bend/are painful when pressed

Summary:
If pain or bend in 2 of the 3 locations, 90% chance that Vitamin D is <20 ng
    If not, nothing can be said about vitamin D level

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Monthly Vitamin D doses has been proven to be effective in children

4+ Vitamin D Life pages have both CHILDREN AND MONTHLY in the title
This list is automatically updated

See also Better than Daily

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Giving a child 50,000 IU of vitamin D once a month will greatly reduce the chance of a bone fracture, and greatly improve health

<20 cent capsule monthly = $2/year
50,000 IU capsules from 18+ Amazon suppliers
   Note adults should take 50,000 IU of vitamin D at least twice a month
      Note Both Obese children and adults need to take it twice as often
Alternatives If the child does not want to swallow a pill

1. 50K vitamin D as a liquid
2. Open 50K capsule and pour the tasteless powder into fruit juice, water, etc