Low vitamin D levels associated with slowed fracture healing | Image Credit: © Argus - © Argus - stock.adobe.com.

The healing process of fractures in children can be impacted by low levels of vitamin D, based on research data presented at the American Academy of Pediatrics (AAP) 2024 National Conference & Exhibition, taking place in Orlando, Florida through October 1, 2024.¹

Findings demonstrated that longer healing times were correlated to low levels of vitamin D in fractures that did and did not require surgery, as well as when comparing clinical healing times to radiographic healing times.¹

Jessica McQuerry, MD, was the senior author of the study that evaluated this association.¹

In a press release from the AAP McQuerry stated, “Previous studies have focused more on how Vitamin D can help prevent fractures but now we are seeing a link between low vitamin D levels and longer fracture healing times. Children need to be given well-balanced diets that include Vitamin D for overall health and to make sure when accidents do happen, they can heal appropriately.”¹

Background

Low vitamin D levels have been associated with bone health issues, including impaired calcium absorption, which plays a crucial role in fracture healing. While previous studies have largely focused on Vitamin D's role in fracture prevention, particularly in adults, its influence on healing times in pediatric fractures remains underexplored.¹

The study aimed to examine the relationship between Vitamin D levels and fracture healing times in children. The secondary objective was to evaluate differences in healing times based on fracture location, treatment type (operative versus non-operative), and the presence of Vitamin D supplementation.¹

Study details and findings

A retrospective review was conducted of pediatric patients aged 0-17 years with extremity fractures, recorded between January 2015 and May 2022 at a pediatric healthcare institution. Patients with Osteogenesis Imperfecta were excluded. Data collected included patient demographics, medical history, fracture characteristics, treatment methods, outcomes, vitamin D levels, and supplementation. Vitamin D levels were categorized as²:

· Low - serum levels <30 ng/m

· Normal - serum levels ≥30 ng/ml

Kaplan-Meier curves and Log-Rank tests were used to analyze healing times and conduct subgroup analyses, according to the abstract presented at the AAP meeting.²

The study included 187 fractures among 166 patients ( mean age of 7.9 years [±5.0]). Most patients (62%, n = 103) were male, and 61.4% (n = 102) had low vitamin D levels. Results demonstrated that children with low vitamin D levels experienced significantly longer healing times compared to those with normal vitamin D levels.²

Clinical healing times were extended by 7 days on average (44.0 days vs. 37.0 days, [P = 0.019]), while radiographic healing times were extended by 35 days (74.0 days vs. 39.0 days, [P < 0.001]).²

Lower extremity fractures took notably longer to heal in patients with low vitamin D levels. Clinically, these fractures required an additional 20 days to heal (53.0 days vs. 33.0 days, [P = 0.025]), and radiographically, healing took 56 days longer (95.0 days vs. 39.0 days, [P = 0.006) than in patients with normal vitamin D levels.²

For surgical cases, children with low vitamin D levels healed slower than their normal vitamin D counterparts, with clinical healing times extended by 33 days (83.0 days vs. 50.0 days, [P = 0.031]) and radiographic healing times extended by 115 days (203.0 days vs. 88.0 days, [P = 0.043).²

Additionally, the lack of Vitamin D supplementation in patients with low Vitamin D levels was associated with slower radiographic healing (69.0 days vs. 38.0 days,[P = 0.007]) compared to normal Vitamin D patients.²

Conclusion

This study suggests that low Vitamin D levels are associated with longer clinical and radiographic healing times in pediatric patients with fractures, particularly those involving the lower extremities or requiring surgical intervention. Children with low vitamin D levels experienced significantly delayed healing, both clinically and radiographically, compared to those with normal levels. While the role of vitamin D supplementation remains unclear, the findings indicate that supplementation may help reduce healing times in patients with low vitamin D levels.²

Based on these results, clinicians should consider assessing vitamin D levels in pediatric fracture patients and advising caregivers about the potential for delayed healing when vitamin D levels are below 30 ng/ml.²

“Getting outside and enjoying the fresh air can do wonders for your health while also upping Vitamin D absorption,” said McQuerry. “What a great excuse to get outside and explore nature!”¹

References:

1. Low vitamin D levels in pediatric patients linked to slow healing process. The American Academy of Pediatrics. Press release. September 27, 2024. Accessed September 29, 2024.

2. Low Vitamin D Levels Are Associated with Longer Healing Times in Pediatric Fracture Patients. Abstract. Presented at: 2024 American Academy of Pediatrics National Conference & Exhibition. September 27-October 1, 2024, in Orlando, Florida.