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Obtaining Vitamin D Levels in Children With Fractures Improves Supplementation Compliance

Minkowitz, Barbara, MD*; Nadel, Leah, BA; McDermott, Meghan, BA; Cherna, Zachary, BS*; Ristic, Jennifer, PA-C, MMSc*; Chiu, Stephanie, MPH AHS Bone Health Compliance Group

Journal of Pediatric Orthopaedics: July 2019 - Volume 39 - Issue 6 - p e436–e440
doi: 10.1097/BPO.0000000000001363

Background: Obtaining ideal serum 25-vitamin D (25VitD) levels (>30 ng/mL) is imperative in childhood to achieve peak bone mass. Supplementation compliance in children recommended to take vitamin D postfracture was evaluated. The questions we sought to answer were: Is there (1) a compliance difference between patients with known versus unknown 25VitD levels; (2) an association between compliance and age; and (3) an association between fracture severity and initial 25VitD level.

Methods: One physician analyzed compliance in 1818 fracture patients 2 to 18 years (42% female) with known (48%) and unknown 25VitD. Patient/caregiver’s self-reported adherence to supplementation as “yes” (4 d/wk minimum) or “no” defined compliance. Compliance relating to fracture severity via Abbreviated Injury Scale (AIS), 25VitD level, and age, was analyzed.

Results: Patients with 25VitD levels were more compliant than patients without (61%, n=532/872; 21%, n=206/946; P<0.001). In total, 83% (n=104/125) of AIS 3 patients were compliant, compared with 49% (n=628/1292) of AIS 1/2 patients (P<0.001). Compliance increased with age (odds ratio: 1.09, 95% confidence interval: 1.061-1.120, P<0.001).

Conclusions: Compliance increased when 25VitD levels were obtained, improving with fracture severity. Clinicians should order 25VitD levels on fracture patients to improve supplementation compliance.

Level of Evidence: This is a level IV prognostic study which aims to investigate the effects of various patient characteristics on compliance.

Departments of *Orthopedics

Grants and Research, Atlantic Health System, Morristown Medical Center, Morristown

Drew University, Madison, NJ

AHS Bone Health Compliance Group: Elizabeth J. Adams, Melissa Austin, Gabrielle Foster, Joseph Israeli, Emily Lillie, Elizabeth Reynolds, Amanda Saracinello, Reid Schalet, Sabrina J Shih, Stephanie Simoes.

Ethical Review Committee Statement: The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA).

None of the authors received financial support for this study.

The authors declare no conflicts of interest.

Reprints: Barbara Minkowitz, MD, Morristown Medical Center, 100 Madison Avenue, Morristown, NJ 07960. E-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.