COVID-19 MOVEMENT CONTROL ORDER RELATED OSTEOPOROTIC FRACTURE AND VITAMIN D DEFICIENCY IN AN ADOLESCENT MALE

Abstract

INTRODUCTION/BACKGROUND
COVID-19 pandemic had caused major impacts on various aspects of our life. In Malaysia, Movement Control Order was imposed in March 2020. For almost 2 years, schoolgoing children and adolescents were not able to attend schools physically and their physical activity was confined to their room or house on most days.

CASE
We describe a case of a 14-year-old male, previously active in sports, who sustained a low trauma fracture at the right femoral neck in November 2021 following a prolonged period of extreme sedentary life along with poor dietary intake during the COVID-19 pandemic period. He underwent open reduction and screw fixation for the fracture. Postoperatively, he was initially treated with suboptimal physiotherapy due to worry of fragility fracture. He was thin with a low BMI (15.62 kg/m2) and significant loss of muscle bulk in all limbs. Further laboratory tests showed vitamin D deficiency (15.3 nmol/L) and the dual energy x-ray absorptiometry (DXA) showed low Z-score for total spine (-2.2) and total hip (-3.9). He was treated with activated vitamin D and vitamin D3 replacement. He was later referred to a sports physician for individualized postoperative rehabilitation. By then, he had a 2 cm shortening of the affected limb, which required a customized shoe for correction of the limb length discrepancy. With the customized shoe, he was able to progress his physical activities gradually, from brisk walking to slow jog then later running and cycling outdoors. Successive clinic visits showed remarkable improvement in physical fitness, sports participation and normalization of vitamin D levels. With guidance from a sports physician, he was able to resume sports activities eventually without limitation or difficulty. Repeated DXA scans within one year showed significant improvement.

CONCLUSION
Physical activity and vitamin D are important essentials in bone growth and bone health in adolescents.