NOT ONLY VITAMIN D BUT HAEMOGLOBIN IS ALSO ASSOCIATED WITH ARM FRACTURES IN PAEDIATRIC PATIENTS!!
Main Article Content
Keywords
Vitamin D deficiency, Low impact upper extremity fractures, Low Hemoglobin, Arm fracture, High versus Low impact fracture, Anemia
Abstract
Introduction:
Vitamin D deficiency usually linked with skeletal complications includes rickets, bone deformities, osteoporosis and fractures. The aim of the present study was to determine the prevalence of vitamin D deficiency in under 6 years paediatric patients presented with radiographically confirmed fracture of upper arm extremity.
Material and methods
This cross-sectional descriptive study was conducted at a tertiary care centre in western Maharashtra between Jan 2019 to Dec 2021. All pediatric patients under 6 years with radiographically confirmed fracture of upper extremity during the study period were compared with collected serum levels of 25(OH) vitamin D and haemoglobin by using an electronic statistical package SPSS software version 23.0 (SPSS, IBM, Chicago, IL, USA).
Results
A total of 62 children were enrolled in the study. In our study, almost three fourth (47, 75.8%) of children with upper extremity fracture were deficient (< 20ng/ml) in serum levels of 25(OH) vitamin D. The statistical comparison of median serum haemoglobin level and mode of injury by using Mann Whitney U test was significant, p-value = 0.002 whereas, statistical comparison of median serum levels of 25(OH) vitamin D and mode of injury was found to be non-significant, p-value = 0.133.
Conclusion
We found almost 75% children in our study were suffering from Vit D deficiency. However, this study showed a potentially important association between low serum haemoglobin levels and fracture due to low impact injury in children. This finding opens-up a window of opportunity for research on the effect of haemoglobin and possibly nutritional status on bone health.
References
2. "Office of Dietary Supplements - Vitamin D". ods.od.nih.gov. October 9, 2020. Retrieved October 31, 2020.
3. Norman AW (August 2008). "From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health". The American Journal of Clinical Nutrition. 88 (2): 491S 499S. doi:10.1093/ajcn/88.2.491S. PMID 18689389.
4. Amrein, K; Scherkl, M; Hoffmann, M; Neuwersch-Sommeregger, S; Köstenberger, M; Tmava Berisha, A; Martucci, G; Pilz, S; Malle, O (20 January 2020). "Vitamin D deficiency 2.0: an update on the current status worldwide". European Journal of Clinical Nutrition. 74 (11): 1498–1513. doi:10.1038/s41430-020-0558-y. PMC 7091696. PMID 31959942.
5. Holick MF, Chen TC (April 2008). "Vitamin D deficiency: a worldwide problem with health consequences". The American Journal of Clinical Nutrition. 87 (4): 1080S–6S. doi:10.1093/ajcn/87.4.1080S. PMID 18400738.
6. Vitamin D at Merck Manual of Diagnosis and Therapy Professional Edition
7. Ryan LM, Teach SJ, Singer SA, Wood R, Freishtat R, Wright JL, McCarter R, Tosi L, Chamberlain JM. Bone mineral density and vitamin D status among African American children with forearm fractures. Pediatrics 2012;130:e553-560. Epub 2012 Aug 27
8. Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D status in abused and nonabused children younger than 2 years old with fractures. Pediatrics 2011;127:835-841. Epub 2011 Apr 11
9. Perez-Rossello JM, Feldman HA, Kleinman PK, Connolly SA, Fair RA, Myers RM, Gordon CM. Rachitic changes, demineralization, and fracture risk in healthy infants and toddlers with vitamin D deficiency. Radiology 2012;262:234-241. Epub 2011 Nov 21
10. Contreras JJ, Hiestand B, O’Neill JC, Schwartz R, Nadkarni M. Vitamin D deficiency in children with fractures. PediatrEmerg Care 2014;30:777-781.
11. Minkowitz B, Cerame B, Poletick E, Nguyen JT, Formoso ND, Luxenberg SL, Lee BH, Lane JM, Morris-Essex Pediatric Bone Health G. Low Vitamin D Levels are Associated With Need for Surgical Correction of Pediatric Fractures. J PediatrOrthop 2015.
12. Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stocklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012;7:155-172. Epub 2012 Aug 29
13. Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van GoudoeverJ, Nutrition ECo. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013;56:692-701.
14. James JR, Massey PA, Hollister AM, Greber EM. Prevalence of hypovitaminosis D among children with upper extremity fractures. J PediatrOrthop 2013;33:159-162.
15. Ceroni D, Anderson de la Llana R, Martin X, Lamah L, De Coulon G, Turcot K, Dubois-Ferriere V. Prevalence of vitamin D insufficiency in Swiss teenagers with appendicular fractures: a prospective study of 100 cases. J Child Orthop 2012;6:497-503. Epub 2012 Oct 11
16. Olney RC, Mazur JM, Pike LM, Froyen MK, Ramirez-Garnica G, Loveless EA, Mandel DM, Hahn GA, Neal KM, Cummings RJ. Healthy children with frequent fractures: how much evaluation is needed? Pediatrics 2008;121:890-897
17. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997. PMID: 23115811.
18. Ross AC, Manson JE, Abrams SA, et al. The 2011 Report onDietary Reference Intakes for Calcium and Vitamin D From theInstitute of Medicine: What Clinicians Need to Know. J ClinEndocrinol Metab. 2011; 1: 53-58
19. Bischoff-Ferrari H, Willett W. Comment on the IOM Vitamin Dand Calcium Recommendations. Http://Www.Hsph.Harvard.Edu/Nutritionsource/Vitamin-D-Fracture-Prevention/. Accessed Jan 21, 2015
20. Endocrinology Committee NewsLetter Vol 4Jul 04, 2020. https://www.fogsi.org/wp-content/uploads/committee-2020-activities/vol-4-endocrinology-comm-vitamin-d-and-bone-health.pdf
21. Simonelli C, Chen YT, Morancey J, Lewis AF, Abbott TA. Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med. 2003 Jan;18(1):17-22. doi: 10.1046/j.15251497.2003.20387.x. PMID: 12534759; PMCID: PMC1494813
22. Vogiatzi MG, Macklin EA, Fung EB, Cheung AM, Vichinsky E, Olivieri N, Kirby M, Kwiatkowski JL, Cunningham M, Holm IA, Lane J. Bone disease in thalassemia: a frequent and still unresolved problem. Journal of Bone and Mineral Research. 2009 Mar;24(3):543-57.
23. Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. Journal of the American Medical Directors Association. 2006 Jun 1;7(5):287-93.
24. Dharmarajan TS, Norkus EP. Mild anemia and the risk of falls in older adults from nursing homes and the community. Journal of the American Medical Directors Association. 2004 Nov 1;5(6):395-400.
25. Chen Z, Thomson CA, Aickin M, Nicholas JS, Van Wyck D, Lewis CE, Cauley JA, Bassford T; Short list of Women's Health Initiative Investigators. The relationship between incidence of fractures and anemia in older multiethnic women. J Am Geriatr Soc. 2010 Dec;58(12):2337-44. doi: 10.1111/j.1532-5415.2010.03183.x. PMID: 21143442; PMCID: PMC3058294.
26. Chuang MH, Chuang TL, Koo M, Wang YF. Low Hemoglobin Is Associated With Low Bone Mineral Density and High Risk of Bone Fracture in Male Adults: A Retrospective Medical Record Review Study. Am J Mens Health. 2019 May-Jun;13(3):1557988319850378. doi: 10.1177/1557988319850378. PMID: 31081448; PMCID: PMC6537261.