The Role of Nutritional Deficiencies and Micronutrient Status on Pediatric Bone Development in Low-Income Communities
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Background: Nutritional deficiencies may impair skeletal mineralization and contribute to fractures and orthopedic deformities during childhood, particularly in low-resource communities. Objective: To evaluate vitamin D status, estimated calcium and protein intake, and their relationships with pediatric fracture occurrence and orthopedic deformity. Methods: A cross-sectional observational study included 220 children aged 2–15 years attending hospital and community-linked services in Rahim Yar Khan, Pakistan. Clinical, dietary, anthropometric, laboratory, orthopedic, and clinically indicated radiological assessments were performed. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D below 20 ng/mL. Results: Mean age was 9.03 ± 4.01 years, mean vitamin D concentration was 17.96 ± 6.43 ng/mL, mean calcium intake was 541.87 ± 187.99 mg/day, and mean protein intake was 32.81 ± 10.78 g/day. Fractures occurred in 58/220 children (26.4%), while orthopedic deformities were reported in 18.2%. Fracture prevalence was 30.2% among vitamin D-deficient children and 20.9% among non-deficient children. The crude risk ratio was 1.45 (95% CI 0.90–2.34), with an absolute risk difference of 9.4 percentage points (95% CI −2.2 to 20.9; p=0.121). Conclusion: Vitamin D deficiency and suboptimal reported nutrient intake were common. Vitamin D-deficient children had a higher crude fracture proportion, although the association remained statistically inconclusive
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