Classes & Events News Get

Morristown Medical Center Pediatric Orthopedic Surgeon Finds Obtaining Vitamin D Levels in Children with Fractures Improves Compliance

April 5, 2019

Study Recently Published in Prestigious Journal of Pediatric Orthopaedics

Morristown, NJ – A new study by Barbara Minkowitz, MD, a pediatric orthopedist at Atlantic Health System’s Morristown Medical Center published in the prestigious Journal of Pediatric Orthopaedics found that lower vitamin D levels in children are associated with more severe (requiring surgery) fractures and that supplementation compliance improved when vitamin D levels were obtained. 

No other studies to date have examined pediatric vitamin D supplementation compliance and how it relates to serum testing, fracture severity, age, body mass index (BMI), and sex. A recent study found that 1 in 3 children with a fracture can be vitamin D deficient.

The American Academy of Pediatrics recommends that infants and children maintain vitamin D concentrations at > 20 ng/ml. The laboratory values consider > 30 normal, and the Endocrine Society advocates for values between 40-60 ng/ml. Research by Dr. Minkowitz also advocates for values of > 40 ng/ml.

“As a pediatric orthopedic surgeon, I see hundreds of bone breaks ranging in severity each year,” Dr. Minkowitz said. “Vitamin D plays an important role in the regulation of calcium and skeletal growth and strength, and this novel study suggests that if pediatric patients maintain a higher vitamin D level, they may be protected against more severe fractures. In addition, when children get their vitamin D levels tested with a blood draw, they take compliance more seriously and are more adherent with supplementation. I suggest all pediatric patients have their vitamin D levels tested regularly and those with low levels begin supplementation immediately.”

For the study, Dr. Minkowitz and her team assessed 1,818 pediatric patients at her practice between ages 2-18 who had fractures. Of these patients, 872 (48 percent) had a baseline vitamin D level obtained within three weeks of presentation. Four hundred and sixty five of those patients began taking vitamin D with calcium supplements via gummy/candy medications, drops, or pills.

Compliance was assessed at each visit. “Compliant” was defined as taking vitamins a minimum of four days per week during the period of fracture treatment. Compliance duration was an average of two months with a mean of 8.14 months in the 465 patients who began taking vitamin D after their levels were tested post-fracture.

“We found that the more severe the fracture, the better the compliance was,” Dr. Minkowitz said. “We believe patients who had their blood drawn were more compliant because they took it more seriously after being stuck with a needle.”

Age at time of fracture was found to be associated with patient compliance. For every one-year increase in age, a patient was nine percent more likely to be compliant (p < 0.001). The mean age of compliant patients was 10 years old, older than the mean age of noncompliant patients, which was 8 years old (p< 0.001).

In addition to Dr. Minkowitz, the study team included Jennifer Ristic, PA-C, Physician Assistant; Stephanie Chiu, MPH, Manager, Biostatistics and Education, Atlantic Center for Research; and research assistants Leah Nadel, BA, Meghan McDermott, BA, and Zachary Cherna, BS, MMSc. All are part of the Atlantic Health System Bone Health Compliance Group.

About Orthopedics at Atlantic Health System

Atlantic Health System’s Orthopedic program offers residents of New Jersey and the surrounding areas access to high-quality multidisciplinary treatments that span pre-surgical education through post-operative rehabilitation. With the latest diagnostic technologies and robotic equipment, many of our board-certified surgeons are experts in minimally invasive techniques that result in faster recoveries, greater range of motion, and smaller scars.

Each year, the Atlantic Orthopedic Institute performs more than 4,000 joint replacements and treats more than 1,400 traumatic orthopedic injuries, and US News and World Report recognized Morristown Medical Center as a high-performing hospital orthopedics in 2018.

Orthopedists at Morristown Medical Center provide assistance caring for patients with complex fractures of the pelvis and upper and lower extremities. For complex sports injuries, Atlantic Sports Health has highly trained physicians who are experts at diagnosing and treating orthopedic and sports medicine problems and are active participants in academic and research programs. The Orthopedic Oncology program performs limb-sparing surgeries for patients with bone tumors or sarcomas.

For children with orthopedic needs, orthopedists collaborate with pediatricians from Goryeb Children’s Hospital in all aspects of care, including state-of-the-art diagnostics, surgical treatment, and assistive technology.

Atlantic Health System Orthopedics is nationally recognized for its expertise, earning numerous awards and accreditations for its services.

About Atlantic Health System

Atlantic Health System is at the forefront of medicine, setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area. Powered by a workforce of more than 16,800 team members and 4,800 affiliated physicians dedicated to building healthier communities, Atlantic Health System serves more than half of the state of New Jersey including 11 counties and 4.9 million people. The system offers more than 400 sites of care, including six hospitals: Morristown Medical Center in Morristown, NJ, Overlook Medical Center in Summit, NJ, Newton Medical Center in Newton NJ, Chilton Medical Center in Pompton Plains, NJ, Hackettstown Medical Center in Hackettstown, NJ and Goryeb Children’s Hospital in Morristown, NJ.

In addition to the employed workforce, Atlantic Alliance, a Clinically Integrated Network represents more than 2,500 health care providers throughout northern and central NJ. This network includes 1,000 physicians and providers comprising one of the largest multi-specialty practices in New Jersey - Atlantic Medical Group, as well as members of the Atlantic Accountable Care Organization and Optimus Healthcare Partners which work to enhance patient care delivery.

Atlantic Health System provides care for the full continuum of health care needs including 12 urgent care centers, Atlantic Rehabilitation and Atlantic Home Care and Hospice. Facilitating the connection between these services on both land and air is the transportation fleet of Atlantic Mobile Health.

Atlantic Health System leads the Healthcare Transformation Consortium, a partnership of seven regional hospitals and health systems dedicated to improving access and affordability and is a founding member of the PIER Consortium – Partners in Innovation, Education, and Research – a streamlined clinical trial system that will expand access to groundbreaking research across seven health systems in New Jersey.

Atlantic Health System has a medical school affiliation with Thomas Jefferson University and is home to the regional campus of the Sidney Kimmel Medical College at Morristown and Overlook Medical Centers and is the official health care partner of the New York Jets.