HYDERABAD: Children are more susceptible to bone fractures, with many adolescents experiencing at least one fracture during childhood. These fractures can sometimes lead to disability. The prevailing belief for years has been that Vitamin D supplements could prevent such fractures. However, a recent study published in The Lancet Diabetes & Endocrinology reveals that Vitamin D supplements do not effectively prevent bone fractures in children.
Childhood fractures, aside from trauma, can also stem from metabolic causes. Deficiencies in calcium or phosphorus, leading to decreased bone mineral density, are potential culprits. Vitamin D plays a crucial role in absorbing calcium from dietary sources and reabsorbing it at the renal level. It acts as a pivotal link between dietary calcium intake and fracture prevention. Despite this understanding, clinical trials specifically designed to assess the efficacy of Vitamin D supplements in preventing bone fractures in children had not been conducted until now.
Dr Suryaprakash Hedda, Consultant Neonatologist & Pediatrician, Renova Hospitals provided insights on a recent research led by Queen Mary University of London and the Harvard T H Chan School of Public Health. They conducted a clinical trial to determine if Vitamin D supplementation would decrease risk of bone fractures or increase bone strength in school children.
While most participants had Vitamin D deficiency at the study’s baseline, the supplements effectively restored Vitamin D levels to the normal range. However, disappointingly, they had no impact on fracture risk or bone strength, as measured by radial SOS Z scores and quantitative ultrasound in a subset of 1,438 participants.
Hence, they concluded that Vitamin D supplements do not increase bone strength or prevent bone fractures in children with vitamin D deficiency. Despite the discouraging findings, the study recommends a daily intake of 400 IU Vitamin D for preventing conditions like rickets.
Dr Suresh Kumar Panuganti, Lead Consultant-Pediatric Critical Care and Pediatrics, Yashoda Hospitals commenting on the study, highlighted a crucial aspect: “In this study, they have only supplemented Vitamin D. They have not given Calcium or Phosphorus—both are required for bone mineralisation. Vitamin D only helps in better absorption of calcium and aids in reabsorption from kidneys. Vitamin D alone does not prevent fractures. It takes a cumulative effect, including diet, lifestyle, and other factors, to prevent fractures,” he said.
He emphasised the importance of Vitamin D, stating that Vitamin D deficiency can cause rickets in children—a condition affecting multiple organs, including bones, leading to bending of bones, widening of wrist joints, bowing of legs, decreased tone resulting in abdominal wall distension, etc. Therefore, it is essential to supplement Vitamin D to all infants. Additionally, Vitamin D is synthesised under the skin upon exposure to sunlight, making it mandatory for all infants to receive Vitamin D as they may not have adequate exposure to the sun. In medicine, every drug has side effects when taken in excess; similarly, excess Vitamin D supplementation can cause constipation, muscle weakness, irritability, easy fatigability, and can make one prone to renal stones.
Dr Suresh further recommended, “Dietary sources should include enough milk and dairy products, fish, and other seafood, as well as dark green leafy vegetables. Meat, nuts, beans, and lentils are good sources of phosphorus. It is advisable to avoid carbonated drinks”.
Dr Asif Haneef, a Consultant Senior Orthopedic Surgeon at Renova Hospitals, suggested that good food – including a home-cooked balanced diet, fruits, and calcium-rich foods – along with exposure to sunlight and promoting physical activity, are natural key elements to strengthen the skeleton. Additionally, he recommends regular intermittent calcium and vitamin D supplementation to further enhance bone strength. Finally, educating kids about being vigilant and avoiding slips, falls, and accidents can help prevent acute incidents of fractures.