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Vitamin D level and fractures in children and adolescents: a systematic review and meta-analysis



The aim of the study was to determine the relationship between vitamin D levels and the risk of bone fractures in children and adolescents.

Materials and methods

PubMed, Embase, and Cochrane library databases were searched using subject and free words. The Newcastle–Ottawa scale form was used to assess literature quality. ReVman 5.2 and Stata 13.0 were used for statistical analyses. The results were expressed as the mean difference (MD)/odds ratio (OR) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I2 and Q tests. Egger’s test was used to evaluate publication bias.


Thirteen studies (3943 participants ≤ 18 years old) were included, and the quality of the literature was acceptable. Regarding the 25-hydroxyvitamin D (25OHD) level in the random effects model, the MD = − 0.12 ng/mL (95% CI: −1.93, 1.69), I2 = 83%, and P < 0.00001, indicating large heterogeneity. Subgroup analyses were conducted according to vitamin D supplementation and 25OHD level, the sources of heterogeneity were not found. Regarding the proportion of subjects with vitamin D deficiency in the random effects model, OR = 1.09 (95% CI: 0.67, 1.79), I2 = 79%, and P < 0.0001. By sensitivity analysis, after removing Al-Daghri’s study, OR = 1.22 (95% CI: 0.96, 1.56), I2 = 0%, and P = 0.64.


There is no relationship between vitamin D level and the risk of bone fractures in children and adolescents.

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Availability of data and material

The original data can be obtained by email request.

Code availability

Not applicable.



25-Hydroxyvitamin D


Newcastle–Ottawa scale


Odds ratio

95% CI:

95% Confidence interval


Mean difference


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We thank Melissa Crawford, PhD, from Liwen Bianji, Edanz Editing China (, for editing the English text of a draft of this manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



CZ: conceptualization, methodology, and writing—original draft. HL, SR, LL, and KZ: methodology and software. KL: conceptualization and writing—review and editing.

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Correspondence to Kewei Li.

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The authors report no conflict of interest related to this work.

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All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

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Informed consent was obtained from all individual participants included in the study.

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This manuscript has been approved by all the co-authors and has not been published before.

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Zheng, C., Li, H., Rong, S. et al. Vitamin D level and fractures in children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab 39, 851–857 (2021).

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  • Vitamin D
  • Bone fracture
  • Children
  • Adolescent