Part I utilizes an economic modeling system to address whether health insurance serves as a compliance incentive for pediatric fracture patients. The model concluded that health insurance had no effect on compliance level and that compliance level determined osteoporosis-related costs and expected labor income. Part II uses a retrospective analysis of a pediatric population to determine which factors impact compliance to a vitamin D supplementation protocol following a fracture. The results showed that patients with lower levels of baseline vitamin D were more likely to comply to the regimen. Part III uses a prospective longitudinal intervention study approach in a pediatric population to address how to improve compliance with a vitamin D supplementation protocol following a fracture. The study follows patients with dual x-ray absorptiometry (DEXA) scans at three time points during the healing processes in addition to vitamin D levels. Preliminary data indicate that the DEXA scans help promote compliance to the vitamin D supplementation protocol and that patients following the protocol show significant improvements in bone mineral density (BMD) relative to expected changes in bone mineral content (BMC).

Results from all three parts of the analysis indicate that making silent illnesses, such as fracture risk and poor bone mineralization, more salient improves the likelihood that patients will comply with a vitamin D supplementation protocol following a fracture. DEXA scans have been able to increase compliance rates, and the results from the follow up scans are promising. The American Academy of Pediatrics (AAP) should take a formal stance on the preventive role of vitamin D in pediatric bone health, requiring physicians to annually monitor levels and to include vitamin D monitoring in sports physicals. Adolescence is a critical time to maximized peak bone mass to stave off future osteoporosis risk.