gms | German Medical Science

Objectives: In the past decades, an increased interest in the role of vitamin D has become evident, particularly in bone health and prevention of bone fractures in children and adolescents.

Aim of this study was to investigate the prevalence and effect of vitamin D deficiency in children and adolescents with low-energy fractures in Lebanon, a Middle East and North Africa (MENA) country with over 300 days of sunshine per year. Furthermore, we tried to identify the risk factors associated with a vitamin D deficiency in the same cohort compared to fracture-free matched individuals.

Methods: All children and adolescents aged 1 to 15 years that presented to the Emergency Department of a level one trauma centre in Lebanon with low-energy fractures over a period of 16 months were included. Controls were children with no history of fractures or bone disease from the outpatient department. In all cases conventional x-ray and laboratory blood tests were performed. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D level smaller as 20 ng/ mL or 49.92 nmol/ L. Statistical analysis was completed using t-tests, chi-squared tests, analysis of variance, and multiple logistic regression models.

Results and Conclusion: Final sample included 37 cases (30 males, 7 females, 7.4 ± 3.7 years) and 70 control individuals (42 males, 28 females, 7.8 ± 4.6 years) without significant differences regarding age, gender and month of inclusion. Children with fractures had lower levels of vitamin D (21.868 ± 8.402 ng/ mL vs. 25.887 ± 7.620 ng/ mL) (p 0.014). Vitamin D deficiency was associated with higher rates of low-energy fractures (OR 1.076, 95% CI [1.013 - 1.143], p 0.0163) as males showed 3 times greater risk than females (OR 3.003, [1.121 - 8.065], p 0.0287). Finally, vitamin D deficiency correlated with almost 5 times increased risk of low-energy fractures (OR 4.628, [1.915 - 11.184], p 0.0007).

This is the first MENA study establishing a relation between vitamin D deficiency and low-energy fractures among children and adolescents. Monitoring of the vitamin D level should be recommended in MENA countries to prevent serious consequences and burden on children, their families, and the socioeconomic health system.