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Nutrients. 2018 Jun 6;10(6). pii: E734. doi: 10.3390/nu10060734.

Decreased Levels of Circulating Carboxylated Osteocalcin in Children with Low Energy Fractures: A Pilot Study.

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Department of Pediatric Orthopedics and Traumatology, Medical University of Białystok, 15-089 Białystok, Poland.
Department of Pediatric Orthopedics and Traumatology, Medical University of Białystok, 15-089 Białystok, Poland.
Faculty of Health Sciences, Lomza State University of Applied Sciences, 18-400 Łomża, Poland.
International Science &Health Foundation, 30-148 Krakow, Poland.
Department of Statistics and Medical Informatics, Medical University of Białystok, 15-089 Białystok, Poland.
American Medical Holdings Inc., New York, NY 10314, USA.
Department of Biochemistry, Cardiovascular Research Institute Maastricht, University Maastricht, 6200 MD Maastricht, The Netherlands.



In the past decades, an increased interest in the roles of vitamin D and K has become evident, in particular in relation to bone health and prevention of bone fractures. The aim of the current study was to evaluate vitamin D and K status in children with low-energy fractures and in children without fractures.


The study group of 20 children (14 boys, 6 girls) aged 5 to 15 years old, with radiologically confirmed low-energy fractures was compared with the control group of 19 healthy children (9 boys, 10 girls), aged 7 to 17 years old, without fractures. Total vitamin D (25(OH)D3 plus 25(OH)D2), calcium, BALP (bone alkaline phosphatase), NTx (N-terminal telopeptide), and uncarboxylated (ucOC) and carboxylated osteocalcin (cOC) serum concentrations were evaluated. Ratio of serum uncarboxylated osteocalcin to serum carboxylated osteocalcin ucOC:cOC (UCR) was used as an indicator of bone vitamin K status. Logistic regression models were created to establish UCR influence for odds ratio of low-energy fractures in both groups.


There were no statistically significant differences in the serum calcium, NTx, BALP, or total vitamin D levels between the two groups. There was, however, a statistically significant difference in the UCR ratio. The median UCR in the fracture group was 0.471 compared with the control group value of 0.245 (p < 0.0001). In the logistic regression analysis, odds ratio of low-energy fractures for UCR was calculated, with an increased risk of fractures by some 78.3 times.


In this pilot study, better vitamin K status expressed as the ratio of ucOC:cOC-UCR&mdash;is positively and statistically significantly correlated with lower rate of low-energy fracture incidence.


bone low energy fractures; children; vitamin K deficiency

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