{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:55:37Z","timestamp":1791053737777,"version":"4.1.0"},"reference-count":128,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T00:00:00Z","timestamp":1687132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Vitamin D plays a vital role in regulating calcium and phosphate metabolism and maintaining bone health. A state of prolonged or profound vitamin D deficiency (VDD) can result in rickets in children and osteomalacia in children and adults. Recent studies have demonstrated the pleiotropic action of vitamin D and identified its effects on multiple biological processes in addition to bone health. VDD is more prevalent in chronic childhood conditions such as long-standing systemic illnesses affecting the renal, liver, gastrointestinal, skin, neurologic and musculoskeletal systems. VDD superimposed on the underlying disease process and treatments that can adversely affect bone turnover can all add to the disease burden in these groups of children. The current review outlines the causes and mechanisms underlying poor bone health in certain groups of children and young people with chronic diseases with an emphasis on the proactive screening and treatment of VDD.<\/jats:p>","DOI":"10.3390\/nu15122805","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T01:59:30Z","timestamp":1687226370000},"page":"2805","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Vitamin D Deficiency in Chronic Childhood Disorders: Importance of Screening and Prevention"],"prefix":"10.3390","volume":"15","author":[{"given":"Madhura","family":"Joshi","sequence":"first","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7278-0734","authenticated-orcid":false,"given":"Suma","family":"Uday","sequence":"additional","affiliation":[{"name":"Birmingham Women\u2019s and Children\u2019s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK"},{"name":"Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e210594","DOI":"10.1530\/EC-21-0594","article-title":"100 Years of vitamin D: Historical aspects of vitamin D","volume":"11","author":"Jones","year":"2022","journal-title":"Endocr. Connect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1093\/jn\/134.6.1299","article-title":"The discovery of vitamin D: The contribution of Adolf Windaus","volume":"134","author":"Wolf","year":"2004","journal-title":"J. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1152\/physrev.1998.78.4.1193","article-title":"Current Understanding of the Molecular Actions of Vitamin D","volume":"78","author":"Jones","year":"1998","journal-title":"Physiol. Rev."},{"key":"ref_4","first-page":"E8","article-title":"The effect of additions of fluorine to the diet of the rat on the quality of the teeth. 1925. Studies on experimental rickets. XXI. An experimental demonstration of the existence of a vitamin which promotes calcium deposition. 1922. The effect of additions of fluorine to the diet of the rat on the quality of the teeth. 1925","volume":"277","author":"McCollum","year":"2002","journal-title":"J. Biol. Chem."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ijpp.2018.01.002","article-title":"The discovery and synthesis of the nutritional factor vitamin D","volume":"23","author":"Jones","year":"2018","journal-title":"Int. J. Paleopathol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1042\/bj1150269","article-title":"Metabolism of vitamin D. A new cholecalciferol metabolite, involving loss of hydrogen at C-1, in chick intestinal nuclei","volume":"115","author":"Lawson","year":"1969","journal-title":"Biochem. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1111\/j.1753-4887.1998.tb01686.x","article-title":"Mechanisms and functions of vitamin D","volume":"56","author":"DeLuca","year":"1998","journal-title":"Nutr. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1021\/bi00790a023","article-title":"Isolation and identification of 1,25-dihydroxycholecalciferol. A metabolite of vitamin D active in intestine","volume":"10","author":"DeLuca","year":"1971","journal-title":"Biochemistry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S1387-2656(01)07037-5","article-title":"Enzymatic studies on the key enzymes of vitamin D metabolism; 1 alpha-hydroxylase (CYP27B1) and 24-hydroxylase (CYP24)","volume":"7","author":"Inouye","year":"2001","journal-title":"Biotechnol. Annu. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e210554","DOI":"10.1530\/EC-21-0554","article-title":"Autoimmune disease and interconnections with vitamin D","volume":"11","author":"Fletcher","year":"2022","journal-title":"Endocr. Connect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"898125","DOI":"10.5402\/2013\/898125","article-title":"The pleiotropic effect of vitamin D","volume":"2013","author":"Lai","year":"2013","journal-title":"ISRN Nephrol."},{"key":"ref_13","unstructured":"(2023, May 15). Ultraviolet Radiation, Vitamin D and Health Report of the Independent Advisory Group on Non-Ionising Radiation, Available online: https:\/\/www.gov.uk\/government\/publications\/ultraviolet-radiation-and-vitamin-d-the-effects-on-health."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"356","DOI":"10.4103\/ijmr.IJMR_1961_19","article-title":"Nutritional rickets & osteomalacia: A practical approach to management","volume":"152","author":"Uday","year":"2020","journal-title":"Indian J. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Al-Daghri, N.M., Yakout, S., Sabico, S., Wani, K., Hussain, S.D., Aljohani, N., Uday, S., and H\u00f6gler, W. (2022). Establishing the Prevalence of Osteomalacia in Arab Adolescents Using Biochemical Markers of Bone Health. Nutrients, 14.","DOI":"10.3390\/nu14245354"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1111\/bjd.12518","article-title":"Lifestyle factors including less cutaneous sun exposure contribute to starkly lower vitamin D levels in U.K. South Asians compared with the white population","volume":"169","author":"Kift","year":"2013","journal-title":"Br. J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1136\/archdischild-2018-314826","article-title":"Prevention of rickets and osteomalacia in the UK: Political action overdue","volume":"103","author":"Uday","year":"2018","journal-title":"Arch. Dis. Child."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1159\/000443136","article-title":"Global Consensus Recommendations on Prevention and Management of Nutritional Rickets","volume":"85","author":"Munns","year":"2016","journal-title":"Horm. Res. Paediatr."},{"key":"ref_19","unstructured":"Arundel, P., and Shaw, N. (2023, May 07). Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management in Children and Young People Camerton, Somerset, England, 2018. Available online: https:\/\/theros.org.uk\/media\/54vpzzaa\/ros-vitamin-d-and-bone-health-in-children-november-2018.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s13312-022-2448-y","article-title":"Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets","volume":"59","author":"Gupta","year":"2022","journal-title":"Indian Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1126\/science.6251551","article-title":"Photosynthesis of previtamin D3 in human skin and the physiologic consequences","volume":"210","author":"Holick","year":"1980","journal-title":"Science"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1073\/pnas.68.9.2131","article-title":"Regulation by calcium of in vivo synthesis of 1,25-dihydroxycholecalciferol and 21,25-dihydroxycholecalciferol","volume":"68","author":"Boyle","year":"1971","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/pr.2013.139","article-title":"Relationship between serum 25-hydroxyvitamin D and parathyroid hormone in the search for a biochemical definition of vitamin D deficiency in children","volume":"74","author":"Atapattu","year":"2013","journal-title":"Pediatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.mce.2011.05.038","article-title":"Vitamin D and intestinal calcium absorption","volume":"347","author":"Christakos","year":"2011","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.chembiol.2013.12.016","article-title":"Vitamin D metabolism, mechanism of action, and clinical applications","volume":"21","author":"Bikle","year":"2014","journal-title":"Chem. Biol."},{"key":"ref_27","first-page":"13","article-title":"Vitamin D metabolism: New concepts and clinical implications","volume":"24","author":"Anderson","year":"2003","journal-title":"Clin. Biochem. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.paed.2021.06.006","article-title":"A clinician\u2019s guide to vitamin D and bone health in children","volume":"31","author":"Nadar","year":"2021","journal-title":"Paediatr. Child. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know","volume":"96","author":"Ross","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1007\/s00467-021-05328-w","article-title":"Rickets guidance: Part I-diagnostic workup","volume":"37","author":"Haffner","year":"2022","journal-title":"Pediatr. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.berh.2007.11.006","article-title":"Hypercalcaemic and hypocalcaemic conditions due to calcium-sensing receptor mutations","volume":"22","author":"Egbuna","year":"2008","journal-title":"Best. Pract. Res. Clin. Rheumatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1111445","DOI":"10.3389\/fendo.2023.1111445","article-title":"Alkaline phosphatase in clinical practice in childhood: Focus on rickets","volume":"14","author":"Cannalire","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1007\/s00467-012-2175-z","article-title":"Phosphate homeostasis and its role in bone health","volume":"27","author":"Alon","year":"2012","journal-title":"Pediatr. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/ar.1092290404","article-title":"Rearrangement of the metaphyseal vasculature of the rat growth plate in rickets and rachitic reversal: A model of vascular arrest and angiogenesis renewed","volume":"229","author":"Hunter","year":"1991","journal-title":"Anat. Rec."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jsbmb.2019.01.004","article-title":"Spot the silent sufferers: A call for clinical diagnostic criteria for solar and nutritional osteomalacia","volume":"188","author":"Uday","year":"2019","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1136\/adc.2003.031385","article-title":"Presentation of vitamin D deficiency","volume":"89","author":"Ladhani","year":"2004","journal-title":"Arch. Dis. Child."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1136\/adc.84.6.501","article-title":"Symptomatic rickets in adolescence","volume":"84","author":"Narchi","year":"2001","journal-title":"Arch. Dis. Child."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1136\/archdischild-2019-317934","article-title":"Nutritional rickets under 16 years: UK surveillance results","volume":"105","author":"Julies","year":"2020","journal-title":"Arch. Dis. Child."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"300","DOI":"10.4254\/wjh.v3.i12.300","article-title":"Hepatic osteodystrophy: An important matter for consideration in chronic liver disease","volume":"3","author":"Lucendo","year":"2011","journal-title":"World J. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2215\/CJN.05940611","article-title":"Early skeletal and biochemical alterations in pediatric chronic kidney disease","volume":"7","author":"Pereira","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1002\/hep.21852","article-title":"Bone disorders in chronic liver disease","volume":"46","author":"Collier","year":"2007","journal-title":"Hepatology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/S0168-8278(98)80253-5","article-title":"Bone disease in patients with primary sclerosing cholangitis: Prevalence, severity and prediction of progression","volume":"29","author":"Angulo","year":"1998","journal-title":"J. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jeong, H.M., and Kim, D.J. (2019). Bone Diseases in Patients with Chronic Liver Disease. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20174270"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s00774-013-0524-z","article-title":"Effect of liver dysfunction on circulating sclerostin","volume":"32","author":"Rhee","year":"2014","journal-title":"J. Bone Miner. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1177\/2042018816641351","article-title":"Osteoporosis in liver disease: Pathogenesis and management","volume":"7","author":"Holecki","year":"2016","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00198-008-0701-4","article-title":"Association between iron overload and osteoporosis in patients with hereditary hemochromatosis","volume":"20","author":"Valenti","year":"2009","journal-title":"Osteoporos. Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1007\/s10620-009-1069-9","article-title":"Prevalence of vitamin D deficiency in chronic liver disease","volume":"55","author":"Arteh","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/liv.12106","article-title":"Vitamin D in chronic liver disease","volume":"33","author":"Stokes","year":"2013","journal-title":"Liver Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.pedneo.2018.03.011","article-title":"Vitamin D non-sufficiency is prevalent in children with chronic liver disease in a tropical country","volume":"60","author":"Lee","year":"2019","journal-title":"Pediatr. Neonatol."},{"key":"ref_50","first-page":"305","article-title":"Vitamin D deficiency in chronic liver disease, clinical-epidemiological analysis and report after vitamin d supplementation","volume":"39","year":"2016","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1002\/lt.23646","article-title":"High prevalence of vitamin A deficiency and vitamin D deficiency in patients evaluated for liver transplantation","volume":"19","author":"Venu","year":"2013","journal-title":"Liver Transpl."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3748\/wjg.v22.i1.72","article-title":"Molecular changes in hepatic metabolism and transport in cirrhosis and their functional importance","volume":"22","author":"Dietrich","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/jcsm.12269","article-title":"Association between pre-sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C","volume":"9","author":"Bering","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_54","unstructured":"Kyrana, E. (2022). Liver Disease in Adolescence, Springer. Available online: https:\/\/link.springer.com\/10.1007\/978-3-030-98808-1_1."},{"key":"ref_55","first-page":"266","article-title":"Growth and bone health in chronic liver disease and following liver transplantation in children","volume":"7","author":"Baumann","year":"2010","journal-title":"Pediatr. Endocrinol. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1172\/JCI2799","article-title":"Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone","volume":"102","author":"Weinstein","year":"1998","journal-title":"J. Clin. Investig."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1172\/JCI109506","article-title":"Altered mineral metabolism in glucocorticoid-induced osteopenia. Effect of 25-hydroxyvitamin D administration","volume":"64","author":"Hahn","year":"1979","journal-title":"J. Clin. Investig."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1097\/00007890-200206150-00015","article-title":"Bone mineral density and height gain in children with chronic cholestatic liver disease undergoing transplantation","volume":"73","author":"Moniz","year":"2002","journal-title":"Transplantation"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1359\/JBMR.051107","article-title":"Incidence and predictors of fractures in children after solid organ transplantation: A 5-year prospective, population-based study","volume":"21","author":"Helenius","year":"2006","journal-title":"J. Bone Miner. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/MPG.0000000000002443","article-title":"Nutrition Support of Children with Chronic Liver Diseases: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition","volume":"69","author":"Mouzaki","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1002\/hep.21805","article-title":"Fractures and avascular necrosis before and after orthotopic liver transplantation: Long-term follow-up and predictive factors","volume":"46","author":"Guichelaar","year":"2007","journal-title":"Hepatology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"4507","DOI":"10.1210\/jc.2012-1808","article-title":"Long-term follow-up of patients with hypoparathyroidism","volume":"97","author":"Mitchell","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/lt.21488","article-title":"Growth and developmental considerations in pediatric liver transplantation","volume":"14","author":"Alonso","year":"2008","journal-title":"Liver Transpl."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Suchy, F.J., Sokol, R.J., and Balistreri, W.F. (2007). Liver Disease in Children, Cambridge University Press. [4th ed.]. Available online: https:\/\/www.cambridge.org\/core\/product\/identifier\/9780511547409\/type\/book.","DOI":"10.1017\/CBO9780511547409"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1007\/s11154-021-09693-7","article-title":"Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all?","volume":"22","author":"Bilezikian","year":"2021","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1002\/jbmr.340","article-title":"A clinician\u2019s guide to X-linked hypophosphatemia","volume":"26","author":"Carpenter","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_67","first-page":"791","article-title":"Vitamin D Deficiency in Children with Chronic Kidney Disease","volume":"123","author":"Esfandiar","year":"2019","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.3889\/oamjms.2021.6991","article-title":"Vitamin D Deficiency in Children with Chronic Renal Disease","volume":"9","author":"Dyussenova","year":"2021","journal-title":"Open. Access. Maced. J. Med. Sci."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s00467-008-0842-x","article-title":"Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease","volume":"23","author":"Menon","year":"2008","journal-title":"Pediatr. Nephrol."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Balmukhanova, A., Kabulbayev, K., Alpay, H., Kanatbayeva, A., and Balmukhanova, A. (2020). FGF-23 and Phosphate in Children with Chronic Kidney Disease: A Cross-Sectional Study in Kazakhstan. Medicina, 57.","DOI":"10.3390\/medicina57010015"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1093\/ndt\/gfx065","article-title":"Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2\u20135 and on dialysis","volume":"32","author":"Shroff","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/sj.ki.5002009","article-title":"Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease","volume":"71","author":"Levin","year":"2007","journal-title":"Kidney Int."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3339\/jkspn.2020.24.1.14","article-title":"Diagnosis and Management of Chronic Kidney Disease-Mineral Bone Disease in Children","volume":"24","author":"Suh","year":"2020","journal-title":"Child. Kidney Dis."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2017). KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 7, 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"National Kidney Foundation (2003). K\/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J. Kidney Dis., 42, S1\u2013S201.","DOI":"10.1016\/S0272-6386(03)00905-3"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s00467-019-04399-0","article-title":"Treatment of hyperphosphatemia: The dangers of aiming for normal PTH levels","volume":"35","author":"Haffner","year":"2020","journal-title":"Pediatr. Nephrol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2215\/CJN.04760511","article-title":"Ergocalciferol supplementation in children with CKD delays the onset of secondary hyperparathyroidism: A randomized trial","volume":"7","author":"Shroff","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Jean, G., Souberbielle, J.C., and Chazot, C. (2017). Vitamin D in Chronic Kidney Disease and Dialysis Patients. Nutrients, 9.","DOI":"10.3390\/nu9040328"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1038\/s41581-019-0161-4","article-title":"Clinical practice recommendations for growth hormone treatment in children with chronic kidney disease","volume":"15","author":"Drube","year":"2019","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/ibd.20006","article-title":"Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease","volume":"13","author":"Sylvester","year":"2007","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_81","first-page":"52","article-title":"Vitamin D Deficiency in Gastrointestinal Disease","volume":"30","author":"Javorsky","year":"2006","journal-title":"Pract. Gastroenterol."},{"key":"ref_82","unstructured":"IBD Working Group of British Society of Paediatric Gastroenterology Hepatology and Nutrition (2023, May 16). Vitamin D in Paediatric Inflammatory Bowel Disease. Available online: https:\/\/bspghan.org.uk\/wp-content\/uploads\/2020\/11\/BSPGHAN-statement-Vitamin-D-in-IBD-December-2019.pdf."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1080\/20469047.2021.1996089","article-title":"Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: Cohort study","volume":"41","author":"Akhshayaa","year":"2021","journal-title":"Paediatr. Int. Child. Health"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/00000441-200502000-00001","article-title":"Metabolic bone disease after gastric bypass surgery for obesity","volume":"329","author":"Levine","year":"2005","journal-title":"Am. J. Med. Sci."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"827","DOI":"10.3109\/00365528809090768","article-title":"Measurement of the 10,000-molecular weight calcium-binding protein in small-intestinal biopsy specimens from patients with malabsorption syndromes","volume":"23","author":"Staun","year":"1988","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/gut.46.suppl_1.I1","article-title":"Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease","volume":"46","author":"Scott","year":"2000","journal-title":"Gut"},{"key":"ref_87","first-page":"OC17","article-title":"Vertebral Fractures in children with chronic inflammatory and\/or disabling conditions: The SNAP study","volume":"6","author":"Crabtree","year":"2017","journal-title":"Bone Abstr."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"235060","DOI":"10.1155\/2014\/235060","article-title":"Effect of GH\/IGF-1 on Bone Metabolism and Osteoporsosis","volume":"2014","author":"Locatelli","year":"2014","journal-title":"Int. J. Endocrinol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MPG.0b013e31821988a3","article-title":"Skeletal health of children and adolescents with inflammatory bowel disease","volume":"53","author":"Pappa","year":"2011","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1542\/peds.2007-1894","article-title":"Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: Review of current knowledge and recommendations","volume":"122","author":"Misra","year":"2008","journal-title":"Pediatrics"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1097\/MPG.0000000000001896","article-title":"Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition","volume":"66","author":"Miele","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Balachandar, R., and Fabbri, A. (2021). Relative Efficacy of Vitamin D2 and Vitamin D3 in Improving Vitamin D Status: Systematic Review and Meta-Analysis. Nutrients, 13.","DOI":"10.3390\/nu13103328"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1210\/jc.2011-3182","article-title":"Treatment of vitamin D insufficiency in children and adolescents with inflammatory bowel disease: A randomized clinical trial comparing three regimens","volume":"97","author":"Pappa","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_94","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 1289 million children, adolescents, and adults. Lancet, 390, 2627\u20132642."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2147\/NDS.S52024","article-title":"Vitamin D deficiency and childhood obesity: Interactions, implications, and recommendations","volume":"2015","author":"Peterson","year":"2015","journal-title":"Nutr. Diet. Suppl."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jped.2020.08.006","article-title":"Vitamin D deficiency in children and adolescents with obesity: A meta-analysis","volume":"97","author":"Fiamenghi","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_97","first-page":"14977","article-title":"A meta-analysis of the relationship between vitamin D deficiency and obesity","volume":"8","author":"Yao","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/obr.12239","article-title":"Obesity and vitamin D deficiency: A systematic review and meta-analysis","volume":"16","author":"Costa","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","article-title":"Decreased bioavailability of vitamin D in obesity","volume":"72","author":"Wortsman","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I., and Mili\u0107, S. (2019). Vitamin D Deficiency: Consequence or Cause of Obesity?. Medicina, 55.","DOI":"10.3390\/medicina55090541"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1097\/MPG.0b013e318252a13f","article-title":"Diagnosis of nonalcoholic fatty liver disease in children and adolescents: Position paper of the ESPGHAN Hepatology Committee","volume":"54","author":"Vajro","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.numecd.2006.04.002","article-title":"Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease","volume":"17","author":"Targher","year":"2007","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"S192","DOI":"10.4103\/2230-8210.104037","article-title":"Childhood obesity: Determinants, evaluation, and prevention","volume":"16","author":"Raychaudhuri","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/MED.0000000000000371","article-title":"Vitamin D in obesity","volume":"24","author":"Walsh","year":"2017","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.amjmed.2009.06.008","article-title":"Adequacy of vitamin D replacement in severe deficiency is dependent on body mass index","volume":"122","author":"Lee","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_106","first-page":"1060","article-title":"Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects","volume":"75","author":"Theintz","year":"1992","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"4","DOI":"10.7570\/jomes.2019.28.1.4","article-title":"The Impact of Childhood Obesity on Skeletal Health and Development","volume":"28","author":"Dimitri","year":"2019","journal-title":"J. Obes. Metab. Syndr."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1111\/apa.13343","article-title":"Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries","volume":"105","author":"Kim","year":"2016","journal-title":"Acta Paediatr."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s11999-012-2621-z","article-title":"Childhood obesity is associated with increased risk of most lower extremity fractures","volume":"471","author":"Kessler","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_110","unstructured":"American Academy of Orthopaedic Surgeons Position Statement (2023, May 16). The Impact of Obesity on Bone and Joint Health. Available online: https:\/\/www.aaos.org\/contentassets\/1cd7f41417ec4dd4b5c4c48532183b96\/1184-the-impact-of-obesity-on-bone-and-joint-health1.pdf."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1097\/BPO.0b013e3181f5a0b3","article-title":"Increased risk of Blount disease in obese children and adolescents with vitamin D deficiency","volume":"30","author":"Montgomery","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/oby.2007.23","article-title":"Vitamin D status and response to Vitamin D(3) in obese vs. non-obese African American children","volume":"16","author":"Rajakumar","year":"2008","journal-title":"Obesity"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/MPG.0b013e31828f3c05","article-title":"Vitamin D in the healthy European paediatric population","volume":"56","author":"Braegger","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_114","first-page":"31","article-title":"Vitamin D Insufficiency in Children with Chronic Neurological Diseases: Frequency and Causative Factors","volume":"17","author":"Isik","year":"2023","journal-title":"Iran. J. Child. Neurol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s11914-014-0224-1","article-title":"Fractures in Children with Cerebral Palsy","volume":"12","author":"Mughal","year":"2014","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1542\/peds.110.1.e5","article-title":"Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy","volume":"110","author":"Henderson","year":"2002","journal-title":"Pediatrics"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ejpn.2017.08.001","article-title":"Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities","volume":"22","author":"Arslan","year":"2018","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.spen.2017.10.005","article-title":"Bone Health and Endocrine Comorbidities in Pediatric Epilepsy","volume":"24","author":"McNamara","year":"2017","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/MPG.0000000000001646","article-title":"European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Neurological Impairment","volume":"65","author":"Romano","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1542\/peds.2018-0333E","article-title":"Bone Health and Osteoporosis Management of the Patient With Duchenne Muscular Dystrophy","volume":"142","author":"Ward","year":"2018","journal-title":"Pediatrics"},{"key":"ref_121","first-page":"262","article-title":"Vitamin D and the Skin: A Review for Dermatologists","volume":"110","year":"2019","journal-title":"Actas Dermosifiliogr."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s40257-017-0323-8","article-title":"Vitamin D and the Skin: An Update for Dermatologists","volume":"19","author":"Kechichian","year":"2018","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"925503","DOI":"10.3389\/fimmu.2022.925503","article-title":"Impact of Chronic Inflammation in Psoriasis on Bone Metabolism","volume":"13","author":"Saalbach","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.3892\/ijmm.2016.2718","article-title":"Low vitamin D-modulated calcium-regulating proteins in psoriasis vulgaris plaques: S100A7 overexpression depends on joint involvement","volume":"38","author":"Cubillos","year":"2016","journal-title":"Int. J. Mol. Med."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s12020-018-1588-2","article-title":"Glucocorticoid-induced osteoporosis: An update","volume":"61","author":"Compston","year":"2018","journal-title":"Endocrine"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"17130","DOI":"10.1073\/pnas.0508480102","article-title":"Calcineurin regulates bone formation by the osteoblast","volume":"102","author":"Sun","year":"2005","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_127","first-page":"251","article-title":"Methotrexate (MTX) inhibits osteoblastic differentiation in vitro: Possible mechanism of MTX osteopathy","volume":"28","author":"Uehara","year":"2001","journal-title":"J. Rheumatol."},{"key":"ref_128","first-page":"489","article-title":"Methotrexate-induced bone pain in childhood leukemia","volume":"126","author":"Melhorn","year":"1973","journal-title":"Am. J. Dis. Child."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/12\/2805\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:56:33Z","timestamp":1760126193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/12\/2805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,19]]},"references-count":128,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["nu15122805"],"URL":"https:\/\/doi.org\/10.3390\/nu15122805","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,19]]}}}