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.
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Maintaining sufficient calorie intake is essential to support good ______ function in female athletes.
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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.
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Osteoclasts are activated and calcium bioavailability is decreased when 25-OH-D levels are less than ______ ng/mL.
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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.
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Many adolescents are not maintaining adequate vitamin ______ levels.
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Cross-sectional studies have found 25-OH-D deficiency rates between ______% and 47%.
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Certain subpopulations at risk for deficiency include those with dark skin ______.
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Screening radiography does not have a role in looking for bone stress injury in ______ children.
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Magnetic resonance imaging (MRI) is more sensitive than radiography for detecting stress ______ and reactions.
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The specific role of stress fractures in determining the need for ______ is not clearly delineated.
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The triad is defined as caloric intake that is insufficient to support healthy physiologic function and energy needs of ______.
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Some athletes with inadequate energy availability suppress physiologic function even though body weight is ______.
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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.
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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.
