Vitamin D Status in Abused and Nonabused Children Younger Than 2 Years Old With Fractures
Published online April 11, 2011
PEDIATRICS (doi:10.1542/peds.2010-0533)
Samantha Schilling, MDa, Joanne N. Wood, MDa,b, Michael A. Levine, MDa,b, David Langdon, MDa,b, Cindy W. Christian, MDa,b
A Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
B Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Objective To examine vitamin D levels in children with (1) suspected abusive and accidental fractures, (2) single and multiple fractures, and (3) fracture types highly associated with inflicted trauma.
Design and Methods A study of children younger than 2 years of age with fractures admitted to a large children's hospital was performed. Bivariate analysis and test for trend were performed to test for the association of vitamin D status and biochemical markers of bone health with the primary outcomes of fracture etiology, number, and type.
Results Of 118 subjects in the study, 8% had deficient vitamin D levels (<20 ng/mL; <50 nmol/L), 31% were insufficient (?20 < 30 ng/mL; ?50 < 78 nmol/L), and 61% were sufficient (?30 ng/mL; ?78 nmol/L). Lower vitamin D levels were associated with higher incidences of hypocalcemia (P = .002) and elevated alkaline phosphatase (P = .05) but not hypophosphatemia (P = .30). The majority of children sustained accidental fractures (60%); 31% were nonaccidental and 9% were indeterminate. There was no association between vitamin D levels and any of the following outcomes: child abuse diagnosis (P = .32), multiple fractures (P = .24), rib fractures (P = .16), or metaphyseal fractures (P = .49).
Conclusions Vitamin D insufficiency is common in young children with fractures but is not more common than in previously studied healthy children. Vitamin D insufficiency was not associated with multiple fractures or diagnosis of child abuse. Nonaccidental trauma remains the most common cause of multiple fractures in young children.
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The children seem to have a lot of vitamin D, much more than the general population. Wonder why