A new study by Dr. Barbara Minkowitz, a pediatric orthopedist at Atlantic Health System’s Morristown Medical Center, published in the prestigious Journal of Pediatric Orthopaedics, found that lower vitamin D levels in children are associated with more severe (requiring surgery) fractures and that supplementation compliance improved when vitamin D levels were obtained.

No other studies to date have examined pediatric vitamin D supplementation compliance and how it relates to serum testing, fracture severity, age, body mass index (BMI), and sex. A recent study found that 1 in 3 children with a fracture can be vitamin D deficient.

The American Academy of Pediatrics recommends that infants and children maintain vitamin D concentrations at > 20 ng/ml. The laboratory values consider > 30 normal, and the Endocrine Society advocates for values between 40–60 ng/ml. Research by Dr. Minkowitz also advocates for values of > 40 ng/ml.

“As a pediatric orthopedic surgeon, I see hundreds of bone breaks ranging in severity each year,” Dr. Minkowitz said. “Vitamin D plays an important role in the regulation of calcium and skeletal growth and strength, and this novel study suggests that if pediatric patients maintain a higher vitamin D level, they may be protected against more severe fractures. In addition, when children get their vitamin D levels tested with a blood draw, they take compliance more seriously and are more adherent with supplementation. I suggest all pediatric patients have their vitamin D levels tested regularly and those with low levels begin supplementation immediately.”

For the study, Dr. Minkowitz and her team assessed 1,818 pediatric patients at her practice between ages 2–18 who had fractures. Of these patients, 872 (48%) had a baseline vitamin D level obtained within 3 weeks of presentation. Four hundred and sixty five of those patients began taking vitamin D with calcium supplements via gummy/candy medications, drops, or pills.

Compliance was assessed at each visit. “Compliant” was defined as taking vitamins a minimum of 4 days per week during the period of fracture treatment. Compliance duration was an average of 2 months with a mean of 8.14 months in the 465 patients who began taking vitamin D after their levels were tested post-fracture.

“We found that the more severe the fracture, the better the compliance was,” Dr. Minkowitz said. “We believe patients who had their blood drawn were more compliant because they took it more seriously after being stuck with a needle.”

Age at time of fracture was found to be associated with patient compliance. For every 1-year increase in age, a patient was 9% more likely to be compliant (P < 0.001). The mean age of compliant patients was 10 years old, older than the mean age of noncompliant patients, which was 8 years old (P < 0.001).

In addition to Dr. Minkowitz, the study team included Jennifer Ristic, PA-C, physician assistant; Stephanie Chiu, MPH, manager, biostatistics and education, Atlantic Center for Research; and research assistants Leah Nadel, BA, Meghan McDermott, BA, and Zachary Cherna, BS, MMSc. All are part of the Atlantic Health System Bone Health Compliance Group.