The role of bone health in low-velocity fractures and the effects of obesity on the growing skeleton

Abstract

ABSTRACT: Vitamin D insufficiency in pediatric patients is common. Low levels of vitamin D affect bone mineralization, and in growing children, affect bone formation. This effect on overall bone health places children with vitamin D insufficiency and deficiency at risk for low-velocity fractures. Counseling pediatric patients on adequate vitamin D and calcium supplementation can decrease long-term bone health deficits and lead to improved health status as adults. In addition, obesity rates continue to increase in children. Obesity has direct effects on bone metabolism that negatively impact growing skeletons. Refined definitions for obesity will help prevent labeling patients inappropriately as obese but also allow physicians to counsel children and their parents on the long-term risks that obesity plays on both bone health and overall health. Key Concepts: (1) Vitamin D has a strong influence on bone health with low levels of vitamin D being associated with low bone mineralization on DEXA scans. (2) Children with low vitamin D are at risk for low-velocity fractures including the need for surgical intervention for these lower energy injuries. (3) Obesity leads to a chronic inflammatory state that creates a negative overall effect on the growing skeleton. (4) Obesity can be a stigmatizing condition resulting from many factors related to socioecological, environmental, and genetic influences but when appropriately addressed, can lead to improved long-term bone and overall health.

Keywords

• Vitamin-D insufficiency
• Obesity
• Adipocytes
• Leptin
• RANKL