Prevalence of vitamin D insufficiency in African American children with forearm fractures: A preliminary study

Objectives: Forearm fractures account for a significant proportion of childhood injuries and seem to be increasing in incidence. Poor vitamin D status increases overall fracture risk in infants with rickets and adults with osteoporosis. Children with vitamin D insufficiency (serum 25-hydroxy vitamin D level <20ng/mL) have decreased bone mineral density (BMD) compared with children having normal vitamin D status. The relationship between vitamin D status and childhood forearm fracture has not been investigated. Methods: This prospective study enrolled African American children, aged 5 to 9 years, with a forearm fracture. Bone health evaluation included measurement of serum 25-hydroxy vitamin D level and BMD by dual energy x-ray absorptiometry scan. Univariable analyses were used to test the associations between fracture status and the independent variables, serum vitamin D level and BMD. Results: Vitamin D levels were available for 17 cases. The mean (±SD) 25-hydroxy vitamin D level was 20.1 (±7.3) ng/mL with a range of 10 to 38ng/mL. The mean of this group was at the cut point for vitamin D insufficiency. Ten cases (59%) were vitamin D insufficient. Dual energy x-ray absorptiometry scan results for these patients were consistent with normal bony mineralization for age. Conclusions: A significant proportion of African American children with fractures in our study have vitamin D insufficiency. Analysis of serum 25-hydroxy vitamin D levels and BMD in additional cases and controls will determine the significance of these findings. Clinical Relevance: Vitamin D insufficiency may play a previously unrecognized role in childhood fractures. Strong consideration should be given to routine vitamin D testing in African American children with forearm fractures.