Bone health

Screen for vit D deficiency in at risk kids, says expert


One of the most common childhood injuries should be used as an opportunity to assess for vitamin D deficiency, says a leading paediatric endocrinologist.

And Associate Professor Christine Rodda has warned against complacency in detecting vit D deficiency in children at risk, saying it remains a significant problem in Australia, particularly in areas with high immigrant populations.

“If you have a child presenting with a fracture and they have risk factors such as high skin pigmentation then it is a good opportunity to check their vitamin D levels,” she said.

Professor Rodda, who is also Associate Professor of Paediatrics at the University of Melbourne, was commenting on an article she co-authored that was published in the journal Bone Reports.

The study set out to determine vitamin D deficiency risk and other lifestyle factors in children aged 2–17 years presenting with an acute fracture to Sunshine Hospital in Melbourne.

Of the 163 patients studied, 134 (82%) had one or more risk factors for vitamin D deficiency, including skin pigmentation, hours spent outdoors, sunscreen use and obesity.

One third of all participants were vitamin D deficient, the researchers found.

“Based on our findings we recommend that vitamin D status be assessed in all children with risk factor of vitamin D deficiency living in urban environments at higher latitudes presenting with fractures,” they wrote.

They added that screening for vitamin D deficiency should include an assessment of dietary calcium intake.

Professor Rodda said tightening of the Medicare requirements had made it harder to routinely screen for Vitamin D deficiency, but it was well-worth the extra effort to screen at-risk patients, including children.

She cited a recent case in which she had treated a six-month-old baby with rickets brought on by severe Vitamin D deficiency. Both the child and mother had dark skin and a number of other risk factors.

Another child with Down Syndrome who hardly ever went outside was brought in with seizures. She was hypocalcaemic and her vitamin D levels were unrecordable.

“A lot of people just think Vitamin D is ho hum – I don’t think they understand the finer details of vitamin D metabolism or how important it is,” Professor Rodda told the limbic.

While the research had found a high prevalence of vitamin D deficiency in multi-ethnic children and teenagers presenting with an acute fracture and one or more risk factors, and children with reduced sun exposure or hyperpigmentation had a strong association with vitamin D deficiency, there were still gaps in related research.

“The effect of vitamin D status on fracture risk and fracture healing in children and teenagers is yet to be determined, as do the effects of vitamin D supplementation in vitamin D deficient paediatric patients presenting with acute fracture,” the authors wrote.

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