VITAMIN D DEFICIENCY AND PEDIATRIC FRACTURES

Symptoms of rickets were first mentioned by Soranus of Ephesus in the 2nd century AD, then the first definition of rickets was made in the 17th century. Approximately a century ago, great advances were recorded in the causes and treatment of rickets. Rickets caused by Vitamin D deficiency in the pediatric age group is a bone mineralisation disorder. By undergoing hydroxylation in the liver and kidneys, Vitamin D converts to the active form that binds to Vitamin D receptors (VDR). Lack of Vitamin D, which is a health issue at different levels in countries worldwide is due to insufficient exposure to sunlight, an unbalanced diet, chronic diseases, and genetic factors. The primary source of Vitamin D is sunlight. Vitamin D synthesis with UVB rays in sunlight is affected by an increased amount of mela-nin, clothing coverage, season, latitude, and hours of sunlight exposure. With a decrease in Vitamin D precursors in the skin together with ageing, Vitamin D synthesis decreases. Few foods such as oily fish (salmon, mackerel) and offal are sources of Vitamin D. Insufficient dietary intake can cause nutritional rickets. Other than nutritional Vitamin D deficiency, rickets can be seen secondary to renal phosphorus loss and mutation of the gene responsible for the production of 1-alpha hydroxylase enzyme. Anti-ep-ileptic drugs, glucocorticoids, diseases causing lipid malabsorption and malignant tumours can also cause Vitamin D deficiency. Trauma is the most common cause of fractures in the pediatric period, seen most often after a fall and in the upper extremities. They can also be caused by high-energy trau-ma, traffic accidents and falls from height. Lower extremity and open fractures are seen more often. A relationship has been determined between obesity in children and long bone fractures. A decrease in bone mineral density because of Vitamin D deficiency increases the risk of fracture. The American Pediatric Academy defined a normal level of 25 (OH) D as >20 ng/mL. Even if the Vitamn D level is normal at birth, Vitamin D deficiency starts from the 8th week. To prevent Vitamin D deficiency, a dose of 400 IU/day is recommended in the first year of life and 600 IU/day between the ages of 1 and 18 years. The aim of this paper was to present detailed information about Vitamin D metabolism, the effect of deficiency on bone mineralisation, types of rickets, the relationship with pediatric fractures, and prevention and treatment.