ORLANDO, Fla.—Low levels of Vitamin D can impact the healing of fractures in children, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.
The study, “Low Vitamin D Levels Are Associated with Longer Healing Times in Pediatric Fracture Patients,” examined 186 extremity fracture cases in children from 2015 to 2022 and found that low levels of Vitamin D correlated with longer healing times.
This result was found in fractures that did and did not require surgery as well as when comparing clinical healing times to radiographic healing times.
Leg fractures in children with low Vitamin D levels that did not require surgery took an extra 20 days to heal clinically and two months longer to show signs the fracture was disappearing in x-rays. As for those cases where surgery was needed, healing took an extra month to heal clinically and nearly four months for fractures to fade on x-rays.
“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,” said Jessica McQuerry, MD, senior author on the study. “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.”
Vitamin D is primarily found in dairy products such as milk, cheese and yogurt but can also be found in fish and other foods fortified with Vitamin D such as breakfast cereal. Moderate exposure to sunlight can also help the body absorb Vitamin D.
Study authors recommended checking vitamin D levels if your child has a fracture that is taking longer to heal than typical.
“Getting outside and enjoying the fresh air can do wonders for your health while also upping Vitamin D absorption,” Dr. McQuerry said. “What a great excuse to get outside and explore nature!”
Medical student Michael Guyot is scheduled to present the research, which is below, at 9:30 a.m. on Saturday, Sept. 28 at the Orange County Convention Center, West Building, W311H.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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ABSTRACT
Program Name: 2024 AAP National Conference-Abstracts
Submission Type: Section on Orthopaedics
Abstract Title: Low Vitamin D Levels Are Associated with Longer Healing Times in Pediatric Fracture Patients
Catalina Baez
Gainesville, FL, United States
Vitamin D plays a crucial role in bone health by aiding calcium absorption. While prior studies have explored Vitamin D's link to fracture prevention in adults, its impact on pediatric fracture healing remains underexplored. This study investigates the effect of Vitamin D levels on clinical and radiographic healing time. Secondarily, the effects of upper and lower extremity fractures, operative versus conservative management, and Vitamin D supplementation on the association between Vitamin D levels and healing time were analyzed.
A retrospective review of pediatric patients (ages 0-17) with extremity fractures and Vitamin D levels recorded within a year of injury was conducted from January 2015 to May 2022. Osteogenesis Imperfecta cases were excluded. Data were collected on demographics, medical history, injury characteristics, treatment, outcomes, Vitamin D levels, and supplementation. Vitamin D levels were defined as low (i.e., serum levels < 30 ng/ml) and normal (i.e., serum levels ≥30 ng/ml). Kaplan-Meier curves and Log-Rank tests were used for healing time and subgroup analysis.
A total of 187 fractures among 166 patients were included. Mean age was 7.9 (±5.0) years, and 62.0% (N = 103) of patients were males. Low Vitamin D levels were observed in 61.4% (n = 102) of the sample. Low Vitamin D patients had significantly longer clinical (44.0 d vs. 37.0 d, p=0.019) and radiographic (74.0 d vs. 39.0 d, p< 0.001) healing times than normal Vitamin D patients. Lower extremity fractures in low Vitamin D patients healed slower clinically (53.0 vs. 33.0 d, p=0.025) and radiographically (95.0 d vs. 39 d, p=0.006) than in normal Vitamin D patients. Similarly, surgical patients with low Vit D levels also healed slower than their normal Vitamin D counterparts clinically (83.0 vs. 50.0 d, p=0.031) and radiographically (203.0 vs. 88.0 d, p=0.043). Lack of supplementation in low Vitamin D patients was associated with longer radiographic healing times (69.0 d) than in normal Vitamin D patients (38.0 d, p=0.007).
Our findings suggest a link between low Vitamin D and slower clinical and radiographic healing in pediatric patients with lower extremity fractures and surgical management. Although the role of Vitamin D supplementation is unclear, the lack of supplementation in patients with decreased Vitamin D levels was associated with slower radiographic fracture healing. As such, surgeons should consider evaluating Vitamin D levels in pediatric fracture patients and advise on the potential for slower bone healing when these levels are below 30ng/ml.
Table 1. Median clinical and radiographic healing times.
Figure 1
Figure 1A. Kaplan-Meier curves for clinical (left) and radiographic (right) healing times in lower extremity fracture patients comparing across low and normal Vitamin D levels. Figure 1B. Kaplan-Meier curves for clinical (left) and radiographic (right) healing times in operative fracture patients comparing across low and normal Vitamin D levels. Note all censored cases corresponded to failure to achieve fracture healing following the initial treatment.