Vitamin D Status and Screening Practices Among Pediatric Fracture Patients With Autism Spectrum Disorder: A Retrospective Matched Cohort Study
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 χ 2 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…
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