ESPE Yearbook of Paediatric Endocrinology

Bone Miner Metab. 2021 Sep;39(5):851-857Abstract: https://pubmed-ncbi-nlm-nih-gov.proxy.kib.ki.se/34115219/

In brief: Vitamin D plays a pivotal role in calcium homeostasis and bone health; a question is therefore frequently raised regarding the risk of fractures in children with vitamin D deficiency. This is more pertinent in safeguarding cases where it is not uncommon to find fractures along with vitamin D deficiency or insufficiency. In this meta-analysis, no relationship between vitamin D levels and the risk of bone fractures in children and adolescents was found.

Commentary: In this meta-analysis, the authors identified 13 studies with 3983 participants <18 years old (n=2570 in the control group and n=1373 in the fracture group) that reported bone fractures and 25OHD values. Children with metabolic bone disorders including rickets, chronic diseases and prolonged steroid use were excluded. Using the Newcastle–Ottawa scale, 2 articles were of moderate quality and 11 articles were of high quality.

There were no significant differences in 25OHD levels in the control and fracture groups; there was no publication bias (P = 0.282 in Egger’s test). Sensitivity analysis, OR = 1.22 (95% CI: 0.96, 1.56), I2 = 0%, and P = 0.64 demonstrated no significant difference in the proportion of subjects with vitamin D deficiency between the fracture and control groups; there was no publication bias (P = 0.156 in Egger’s test). These analyses suggest that fractures in children may not be related to vitamin D levels. Given that only case-control and cross-sectional studies were included in the analyses (because of the inclusion criteria), large cohort studies and their metanalyses will be required to confirm the role of vitamin D deficiency and insufficiency in fractures in children and adolescents.