Journal of Pediatric Orthopaedics - 2026-07-20 - Journal Article
Vitamin D Status and Screening Practices Among Pediatric Fracture Patients With Autism Spectrum Disorder: A Retrospective Matched Cohort Study.
Murata A, Chehab M, Rajjoub R, Slyepkan I, Tulchin-Francis K, Tabaie S
Topics
Key Takeaway
Low vitamin D prevalence was 52% among pediatric fracture patients overall, with no significant difference between ASD (54%) and non-ASD (48%) cohorts, while orthopaedic services ordered only 5% of vitamin D tests.
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Summary
This study asked whether pediatric fracture patients with ASD have higher rates of vitamin D insufficiency and whether screening practices differ from matched controls. Among 290 patients treated for fractures at a single institution from 2012–2024, only 30% received any vitamin D testing; ASD patients were tested more frequently (46% vs. 14%, P<0.001), but low vitamin D prevalence did not differ between groups (54% vs. 48%, P=0.8). Atypical antipsychotic use (OR=7.6) and worse Area Deprivation Index score (OR=1.3) were the strongest predictors of testing and low vitamin D levels, respectively, while orthopaedic services initiated only 4 of 88 tests.
Key Limitation
Only 30% of the cohort had vitamin D levels measured, making it impossible to characterize the true prevalence of insufficiency in the full fracture population and potentially biasing all prevalence estimates.
Original Abstract
BACKGROUND
Vitamin D is essential for pediatric bone health and fracture healing. Children with autism spectrum disorder (ASD) may have risk factors for fracture injuries and vitamin D insufficiency. However, patterns of vitamin D testing and insufficiency among pediatric fracture patients with ASD are not well defined.
METHODS
A single-institution retrospective cohort study of pediatric patients treated for fractures between 2012 and 2024 was conducted. Patients with ASD were compared with an age- and sex-matched cohort without ASD. Chart review identified demographics, comorbidities, medication use, serum 25-hydroxyvitamin D testing, ordering specialty, and supplementation status. Low vitamin D levels were categorized as insufficient and deficient, defined as <30 ng/mL and <20 ng/mL, respectively. Socioeconomic status was assessed using the Area Deprivation Index (ADI) and Childhood Opportunity Index (COI). Cohorts were compared using the χ2 and Fisher exact tests. Logistic regression was used to identify predictors of vitamin D testing and low vitamin D levels.
RESULTS
A total of 290 patients (78% male; 145 ASD, 145 non-ASD) were included. Cohorts were similar in age, sex, race/ethnicity, and BMI. Eighty-eight patients (30%) had vitamin D testing, with testing more common among patients with ASD (67 vs. 21, 46% vs. 14%; P<0.001). Low vitamin D was common (46/88, 52%) and did not differ between groups (ASD 36/67, 54% vs. 10/21, 48%; P=0.8). Most testing was ordered by psychiatry, behavioral health, or primary care, while orthopaedic services ordered 4 tests (5%). Multivariable regression identified ASD (OR=3.7, 95% CI: 1.9-7.6) and atypical antipsychotic use (OR=7.6, CI: 2.7-25.1) as predictors of testing. Increasing age (OR=1.2, CI: 1.1-1.4) and worse ADI (OR=1.3, CI: 1.1-1.6) were predictors of low vitamin D.
CONCLUSIONS
The prevalence of low vitamin D was high among pediatric patients with fractures. Although children with ASD were more frequently tested, the prevalence of low vitamin D was not higher than in children without ASD. Low vitamin D was associated with socioeconomic disadvantage. Screening approaches incorporating socioeconomic risk may complement diagnosis-specific testing practices.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.