Podcast Beta
Questions and Answers
The test most likely to provide information useful in addressing this patient’s concern is a serum total 25-hydroxyvitamin D level (25-OH- ______).
D
The 2014 American Academy of Pediatrics (AAP) clinical report recommends vitamin D screening for those with conditions associated with low bone mass or multiple low-impact ______.
fractures
Stress fractures occur when recovery and nutritional support are inadequate to heal the bony ______ that occurs during high-intensity physical activity.
microtrauma
Preventing stress fractures requires assessment and management of issues that increase ______ development or decrease the body’s capacity for bony recovery.
Signup and view all the answers
Maintaining sufficient calorie intake is essential to support good ______ function in female athletes.
Signup and view all the answers
It is important to recognize that these levels are based on a goal of avoidance of nutritional ______, and do not necessarily represent optimal levels for bone health.
Signup and view all the answers
Osteoclasts are activated and calcium bioavailability is decreased when 25-OH-D levels are less than ______ ng/mL.
Signup and view all the answers
The current recommendation for athletes to minimize injury risk and optimize athletic performance is to maintain 25-OH-D levels between ______ and 50 ng/mL.
Signup and view all the answers
Many adolescents are not maintaining adequate vitamin ______ levels.
Signup and view all the answers
Cross-sectional studies have found 25-OH-D deficiency rates between ______% and 47%.
Signup and view all the answers
Certain subpopulations at risk for deficiency include those with dark skin ______.
Signup and view all the answers
Screening radiography does not have a role in looking for bone stress injury in ______ children.
Signup and view all the answers
Magnetic resonance imaging (MRI) is more sensitive than radiography for detecting stress ______ and reactions.
Signup and view all the answers
The specific role of stress fractures in determining the need for ______ is not clearly delineated.
Signup and view all the answers
The triad is defined as caloric intake that is insufficient to support healthy physiologic function and energy needs of ______.
Signup and view all the answers
Some athletes with inadequate energy availability suppress physiologic function even though body weight is ______.
Signup and view all the answers
Study Notes
Vitamin D Screening and Recommendations
- Serum total 25-hydroxyvitamin D level (25-OH-D) is crucial for assessing vitamin D status, especially in children with low bone mass or multiple low-impact fractures.
- AAP recommends vitamin D screening for high-risk children, including athletes with stress fractures.
- Adequate serum levels of 25-OH-D are debated, with a 2016 consensus suggesting:
- Deficiency: <50 nmol/L
- Insufficiency: 50-75 nmol/L
- Sufficient: >75 nmol/L
Stress Fractures in Athletes
- Stress fractures occur when recovery and nutrition are insufficient during intense physical activity.
- Prevention requires:
- Gradual training increase to avoid microtrauma.
- 36 to 48 hours of rest or light workouts post-hard sessions.
- Sufficient caloric intake to support menstrual function and estrogen levels.
- Adequate vitamin D and calcium intake.
Recommended 25-OH-D Levels
- Levels less than 30 ng/mL (74 nmol/L) decrease calcium bioavailability and activate osteoclasts.
- In athletes and military personnel, stress fracture rates drop when 25-OH-D levels are ≥30 ng/mL.
- Current recommendations for athletes suggest maintaining 25-OH-D levels between 32-50 ng/mL (80-125 nmol/L).
Vitamin D Deficiency in Adolescents
- 25-OH-D deficiency among adolescents ranges from 17% to 47%.
- At-risk groups include:
- Individuals living north of the 35th parallel.
- Those minimizing UVB exposure via clothing/sunscreen.
- Individuals with dark skin pigmentation.
- Overweight or obese adolescents.
- Indoor training athletes such as dancers and gymnasts.
Imaging and Bone Health Assessments
- Screening radiography is not useful for detecting asymptomatic bone stress injuries in children.
- MRI is more sensitive for detecting stress fractures but may lead to overdiagnosis in asymptomatic athletes.
- Bone densitometry recommendations by the AAP apply to:
- Children with ≥2 long bone fractures before age 10.
- Children with ≥3 long bone fractures before age 19.
- Individuals with vertebral fractures without significant trauma.
Female Athlete Triad
- Defined as a combination of insufficient caloric intake for training, menstrual dysfunction, and bone mineral density loss.
- Athletes can experience the triad with low body weight or maintained weight but inadequate energy availability.
- Recognition of stress fractures in young female athletes raises concerns for this triad, indicating the need for further assessment and management.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz focuses on the importance of serum total 25-hydroxyvitamin D levels in children and adolescents. It discusses guidelines from the American Academy of Pediatrics regarding vitamin D screening for those at risk of low bone mass and stress fractures. Test your knowledge on pediatric bone health and the critical role of vitamin D.