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Low Vitamin D Levels in Children with Fractures: a Comparative Cohort Study

HSS Journal Online First Article


The currently accepted ranges for “normal” serum vitamin D have recently been challenged in adults on the basis that healthy bone metabolism requires higher levels of vitamin D than previously thought.

The purpose of this study was to evaluate whether a new “biologically based” classification based on 25(OH)vitamin D levels that invoke an endocrine biomarker response (<20 ng/mL for deficiency and <32 ng/mL for insufficiency) is more appropriate for children with fractures than historical criteria.

Serum 25(OH)vitamin D levels were collected from 58 children with acute low-energy fractures from an outpatient orthopedic clinic from 2009 to 2012. These vitamin D levels were compared with a cohort of 103 children with chronic kidney disease (CKD) from an adjacent clinic, a condition with acknowledged low levels of vitamin D. Then, the prevalence of vitamin D sufficiency in the fracture cohort was evaluated and compared using both historical guidelines and newer biologically based criteria.

25(OH)vitamin D levels in the fracture cohort did not differ from levels in the CKD cohort (27.5 vs. 24.6 ng/mL) indicating a similar distribution of vitamin D levels. This finding was consistent when controlling for significant covariables using linear regression analyses. In the fracture cohort, there was a discrepancy between historical and biologically based criteria in 64% of children.

The results of the current study suggest that fracture patients are more frequently vitamin D deficient than previously thought. This finding is more readily apparent when newer biologically based criteria for vitamin D sufficiency are used.

This Online First article was published online on SpringerLink in August 2015.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


Peter D. Fabricant, MD, MPH
Children’s Hospital of Philadelphia, Philadelphia, PA

Christopher J. Dy, MD, MSPH
Washington University Orthopedics, St. Louis, MO

Son H. McLaren, MD
Weill Cornell Medical College, New York, NY

Ryan C. Rauck, BS
The Ohio State University College of Medicine, Columbus, OH

Headshot of Lisa S. Ipp, MD
Lisa S. Ipp, MD
Chief of Pediatric Medicine, Hospital for Special Surgery
Associate Attending Pediatrician, Hospital for Special Surgery
Headshot of Shevaun Mackie Doyle, MD
Shevaun Mackie Doyle, MD
Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

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