Vitamin D Among Children in Asia

Puberty is the prime time for bone mineral accretion to achieve peak bone mass which is key for determining bone health and preventing osteoporosis in late adulthood. In the absence of physical ailments, the importance of bone health and vitamin D (Vit-D) among children remains under-recognized, and the epidemic of Vit-D insufficiency prevails especially in Asian countries. Studies have shown the association between Vit-D status and bone density and bone quality as measured, respectively, by dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography. In addition to the risk and injury-prone behavior among adolescents, recent literature indicates the peak incidence of pediatric fracture at puberty can be related to skeletal fragility when rapid growth in length at pubertal growth spurts outpaces mineral deposition. Apart from fracture, spinal deformity seen with adolescent idiopathic scoliosis (AIS) has been reported to be associated with low bone mass and poor bone quality. A recent randomized double-blinded placebo-controlled trial addressing the issue provided evidences that calcium plus Vit-D supplementation could improve bone health and prevent deformity progression in AIS especially for those with low baseline Vit-D levels. As far as bone health is concerned, Vit-D insufficiency, not to the extent down to the rickets level of 25 nmol/L over an extended interval of 1–2 years, may not be as asymptomatic as previously thought. For this medical condition that can be readily amendable to supplementation treatment, measures to enhance Vit-D status and good bone health should be promoted both at the public health levels and with enhanced alertness of the condition within the medical profession.