Low Vitamin D Levels Are Associated With Longer Healing Times in Pediatric Fracture Patients

Michael Guyot; William Ross; Catalina Baez; Michael O'Brien; Jessica McQuerry

doi:10.1016/j.jposna.2025.100295

Low Vitamin D Levels Are Associated With Longer Healing Times in Pediatric Fracture Patients

J Pediatr Soc North Am. 2025 Dec 2:14:100295. doi: 10.1016/j.jposna.2025.100295. eCollection 2026 Feb.

Authors

Michael Guyot¹, William Ross¹, Catalina Baez², Michael O'Brien², Jessica McQuerry²

Affiliations

¹ Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, FL, USA.
² Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.

Abstract

Background: Vitamin D plays a crucial role in bone health by aiding calcium absorption. While prior studies have explored the relationship between vitamin D and fracture prevention in adults, its impact on pediatric fracture healing remains underexplored. This study investigates whether low vitamin D levels correlate with longer healing time in pediatric fractures.

Methods: A retrospective review of patients (ages: 0-17 years) with extremity fractures and vitamin D levels within a year of injury was conducted at a single institution in the southeastern United States from January 2015 to May 2022. Data were collected on demographics, medical history, injury specifics, treatment, outcomes, and vitamin D levels and supplementation. Serum vitamin D levels greater than 30.0 ng/mL were defined as "normal" and levels at or below 29.9 ng/mL were defined as "low".

Results: Among 166 patients with 186 fractures, normal vitamin D levels were observed in 38.6% of patients and low vitamin D in 61.4% of patients. Patients with low vitamin D levels had longer clinical (P = .019) and radiographic (P = .001) healing times than those with normal levels. Patients with lower extremity fractures and low vitamin D had longer clinical (P = .025) and radiographic healing times (P = .006). Similarly, within those who required operative management, low vitamin D patients had significantly longer clinical (P = .031) and radiographic (P = .043) healing times.

Conclusions: Our study demonstrates that low vitamin D levels are associated with prolonged clinical and radiographic healing in pediatric patients with fractures, particularly in those with lower extremity fractures and those requiring surgery. Pediatric orthopaedic surgeons should consider evaluation of vitamin D levels in these patients, as healing may be prolonged in patients with low vitamin D levels.

Key concepts: (1)Pediatric patients with low vitamin D levels had longer time to clinical return to activity.(2)Pediatric patients with low vitamin D levels had longer time to radiographic healing.(3)Clinicians should be suspicious of low vitamin D in a pediatric fracture patient with prolonged healing.

Level of evidence: Level III, Cohort Study.

Keywords: Fracture; Healing; Pediatric; Vitamin D.