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Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis

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Abstract

Summary

The association between the risk of fractures and suboptimal vitamin D (Vit-D) status remains controversial in children. This meta-analysis suggested that serum 25(OH)Vit-D levels were lower in pediatric cases with fractures. 25-hydroxyvitamin D (25(OH)Vit-D) levels less than 50 nmol/L were associated with increased fracture risk in children.

Introduction

This study aimed to assess the association between serum 25(OH)Vit-D and the risk of fractures in children, and to explore the sources of heterogeneity and investigate their impact on results.

Methods

Systematic review and meta-analysis were conducted for observational studies comparing serum 25(OH)Vit-D levels between fracture and non-fracture pediatric cases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).

Results

Analysis on 17 case-control and 6 cross-sectional studies (2929 fracture cases and 5000 controls) suggested that 25(OH)Vit-D was lower in fracture cases than in controls (pooled mean difference (MD) = − 3.51 nmol/L; 95% confidence interval (CI): − 5.60 to − 1.42) with a heterogeneity (I2) of 73.9%. The sensitivity analysis which merged the case-control studies that had a NOS score ≥ 4 showed a pooled MD of − 4.35 nmol/L (95% CI: − 6.64 to − 2.06) with a heterogeneity (I2) of 35.9%. Pooled odds ratio of fracture in subjects with 25(OH)Vit-D ≤ 50 nmol/L compared to subjects with 25(OH)Vit-D > 50 nmol/L was 1.29 (95% CI: 1.10 to 1.53; I2 < 1%).

Conclusion

This study indicated that serum 25(OH)Vit-D levels were lower in pediatric patients with fractures. 25(OH)Vit-D ≤ 50 nmol/L was associated with increased fracture risk in children.

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Acknowledgments

We would like to thank Dr. Qiangqiang Li for his kind support in literature search and data extraction.

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Authors and Affiliations

  1. SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

    G. Yang, W.Y.W. Lee, A.L.H. Hung, J.C.Y. Cheng & T.P. Lam

  2. Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    W.Y.W. Lee & A.P.S. Kong

  3. Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China

    M.F. Tang & T.F. Leung

  4. JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

    X. Li

  5. Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China

    A.P.S. Kong

  6. Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China

    T.F. Leung

  7. JC Sports Medicine and Health Sciences Centre, Lui Che Woo Institute of Innovative Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

    P.S.H. Yung

  8. School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China

    K.K.W. To

  9. Joint Research Laboratory of Promoting Globalization of Traditional Chinese Medicines between Shanghai Institute of Materia Medica, Chinese Academy of Sciences and The Chinese University of Hong Kong, Hong Kong SAR, China

    K.K.W. To

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Yang, G., Lee, W., Hung, A. et al. Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Osteoporos Int 32, 1287–1300 (2021). https://doi.org/10.1007/s00198-020-05814-1

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