4. Discussion
rickets, callus, fracture, bone fracture, muscle cramps, pain, fractures, muscle pain, Nutritional Rickets, tenderness, refracture
RICKETS, FRAGILITY, VITAMIN D DEFICIENCY, NUTRITIONAL RICKETS, EPIPHYSIOLYSIS
One in two children between 5 and 18 years of age will suffer at least one fracture, according to a study conducted by Jones IE on a patient pool of 601 [In our study we followed 688 patients between 2 and 17 years of age that suffered a fracture and 889 patients that had no history of fractures, and it was supplemented with a follow-up period of at least 1 year.Vitamin D is a topic of public health interest. Besides its role in calcium homeostasis, it is a multifunctional substance newly classified as a hormone. The optimal serum level in children is yet to be clarified, despite much published research, as well as the optimal protocol for children. Some authors considered sun exposure to be the only healthy way of acquiring vitamin D, whereas others found refractory rickets in the tropics [According to Endocrinology Society guidelines, a serum level of 30 ng/mL (75 nmol/L) is considered normal. A level of under 30 ng/mL but over 20 ng/mL is considered insufficient, and less than 20 ng/mL means deficiency [From our bone fracture study group, we found 31.39% of the patients had insufficient vitamin D levels, 43.75% with deficient levels, and only 24.85% with normal levels. In the unfractured control group, 44.43% of the patients had normal serum vitamin D levels.Some authors suggest reconsidering these target levels based on age groups and medical conditions [In order to increase the serum levels for the bone fracture patients, 2000 I.U./day of vitamin D and 600 mg/day of calcium were given as oral treatment for the following 6 months. We found an average increase of 53.44% in their vitamin D serum levels (from 23.9 ng/mL to 44.76 ng/mL, The overweight/obese patient is associated with a lower serum level of vitamin D. Other signs that may suggest an insufficient level of D3 are atypical muscle pain, pathological bone fractures, epiphysiolysis, weight-bearing joint pain, back pain, difficulty in climbing stairs, pain during running, and muscle cramps. In addition, this pain is symmetrical, without radiation, and accompanied by local tenderness [Kwon DH et al. conducted a study on 163 children who presented a fracture and found that 80% of them had vitamin D deficiencies [Thompson et al. concluded in their study that higher fracture incidence is associated with vitamin D insufficiency in the pediatric population [We found a mean difference of 5 ng/mL between the fractured and unfractured bone groups. Hence, we found a relationship between fracture risk and vitamin D levels among children. We concluded that patients having an under-normal serum level of vitamin D had a 2.127 times higher chance of having a fracture than children with normal levels.According to a study made by Scheimberg [A study made in 2002 by Jones et al. observed a group of 601 children who were monitored between the ages of 5 and 18 and discovered that one in two children suffered at least one fracture during childhood [The Global Consensus Recommendations on Prevention and Management of Nutritional Rickets state that screening for vitamin D deficiency by obtaining a serum 25-OH-D concentration is recommended in patients at increased risk of bone fragility and in those with recurrent low-impact fractures. For these groups, a serum level of 30 ng/mL is considered adequate [Minkowitz et al. had a patient pool of 1031 patients and noted that children with lower levels of vitamin D suffered more severe fractures. They suggested a target level of 40 ng/mL, which is in agreement with our preliminary results [A single case report suggests that hypovitaminosis D is a possible cause of inadequate fracture healing and refracture in children, and it shows a clear effect of vitamin D supplementation on callus formation in the absence of additional variables [Our study’s strength was an adequate patient pool with sufficient data to sustain a thorough statistical analysis. One of our study’s limitations was the lack of long-term follow-up. Future research is needed to see if formerly deficient children who received supplements and have a normal level of vitamin D have the same fracture incidence as the general population.