O3253: Pediatric Bone Health in the Community: Caretaker Comprehension

Background: The physiological importance of calcium and vitamin D intake, specifically in a pediatric population, is readily understood by pediatric orthopedists. However, there is a lack of research that demonstrates caregivers’ awareness in pediatric orthopedic patients’ bone health, such as the importance of nutrition, sunlight exposure and supplementation. Furthermore, there are numerous disparities that exist in pediatric bone health along racial and socioeconomic lines, yet the mechanisms for such disparities remain poorly studied and defined.

Methods: Caregivers of outpatient pediatric orthopedic patients were asked to complete a study-specific questionnaire assessing their knowledge of sources of calcium and vitamin D. Possible scores on this assessment range from +8 to -12 with positive scores reflecting better ability to identify sources of calcium and vitamin D. To help identify potential predictive factors of nutritional knowledge, multiple linear regression models were used to detect whether associations between survey performance and race, educational attainment, self-reported bone health concern, vitamin supplementation, previous fractures, and previous bone health discussion with their doctor existed. Student t-tests and analysis of variance were used to make demographic comparisons.

Results: A total of 184 caregivers were included in the analysis. Caregiver race and current vitamin supplementation were the only significant predictors of overall score when identifying sources of calcium and vitamin D. Results showed that Hispanic/Latino participants scored significantly lower than Black participants by 1.75 (p=.010, 95% CI=[-3.08,-0.43]). Hispanic/Latino participants also scored significantly lower than White participants by 2.24 (p=.000, 95% CI=[-3.34, -1.14]). Other factors were not found to be significant: education (p=0.097), history of fracture (p=0.951), vitamin D intake concerns (p=0.856), and previous counseling by a physician (p=0.163). The overall performance on the questionnaire was assessed to be low, with a standardized mean score of 1.51. 123 participants (66.85%) were in a positive score range, 45 participants (24.46%) were in a negative score range, and 16 participants (8.70%) scored a net of 0. The survey further addressed the participant’s desire to become more educated about vitamin D and calcium with 111 participants (60.33%) wanting more information on the topic and 98 participants (53.26%) wanting a free vitamin D and calcium test, if it were to become available.

Conclusion: There are substantial deficits in caregiver knowledge regarding sources of calcium and vitamin D, particularly among historically marginalized populations. Given that caretakers’ desire to learn more information about vitamin D and calcium was generally high, education and outreach, specifically focused on nutrition, provides an opportunity for orthopedists to better serve the overall bone health of their communities. Developing and utilizing educational materials to make these conversations more fruitful, while imparting lasting knowledge, may be one way to enact this improvement.