Vitamin D and the healing bone: Metabolic underpinnings of pediatric fracture repair

Title : Vitamin D and the healing bone: Metabolic underpinnings of pediatric fracture repair

Abstract:

Introduction: Vitamin D is essential for calcium and phosphate homeostasis and plays a critical role in skeletal growth, mineralization, and bone remodeling during childhood. Hypovitaminosis D is increasingly recognized worldwide and may impair bone mineral accrual and skeletal strength. However, the relationship between vitamin D status and pediatric fracture risk remains controversial, with conflicting findings reported in the literature.

Methods: A narrative review of the literature was conducted to evaluate the biological mechanisms linking vitamin D to bone metabolism and fracture repair in children. Studies examining vitamin D physiology, pediatric fracture epidemiology, and clinical outcomes associated with vitamin D status were analyzed to synthesize current evidence.

Results: Vitamin D regulates intestinal calcium and phosphate absorption and supports osteoblastic activity and mineralization of newly formed bone. Deficiency may lead to secondary hyperparathyroidism, increased bone turnover, and decreased bone mineral density. Several studies demonstrate lower serum vitamin D levels among children presenting with fractures; however, others report no independent association between vitamin D concentration and fracture occurrence, suggesting fracture risk is influenced by multifactorial metabolic, genetic, and environmental determinants.

Conclusion: Vitamin D plays an important biologic role in pediatric bone health and fracture repair. While current evidence regarding its direct association with fracture risk remains inconsistent, optimization of vitamin D status represents a potentially modifiable factor supporting skeletal development and bone healing. Further prospective studies are needed to clarify the role of vitamin D screening and supplementation in pediatric fracture management.

Biography:

Joseph Salem Hernández is a fourth-year medical student at the University of Puerto Rico School of Medicine, expected to graduate in May 2026, with a strong academic focus in orthopaedic surgery and musculoskeletal research. He will serve as an Incoming Orthopaedic Surgery Research Fellow at the Ponce Health Sciences University, Department of Orthopaedic Surgery, where he will continue advancing his clinical and academic contributions to the field. Of Puerto Rican and Lebanese descent, Joseph brings a diverse and global perspective to orthopaedic research. His work spans a broad range of topics including clinical and imaging-related outcomes in distal radius fractures, surgical management of lateral epicondylitis, nerve transfer techniques in brachial plexus injuries, and cross-cultural validation of orthopaedic outcome measures such as the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). He has authored and co-authored multiple peer-reviewed publications in journals such as the Journal of Pediatric Orthopaedics, Journal of Hand Surgery Global Online, Heliyon, and Arthroplasty Today, with ongoing work in upper extremity, spine, and arthroplasty research. His research has been presented extensively at national and international conferences, including the AO Orthopaedic Research Summit (Davos), ICEOS (France), and multiple World Orthopaedic Conferences. Joseph is a recipient of the AO Foundation/ON Foundation Education Grant and the Research Travel Award from the Center for Hispanic Excellence. In addition to his research, he serves as Co-President of the Orthopaedic Surgery Interest Group (OSIG) at UPR, where he leads mentorship, education, and professional development initiatives for students pursuing orthopaedics. With a strong foundation in both clinical research and academic leadership, Joseph is committed to advancing evidence-based orthopaedic care and contributing meaningfully to the academic growth of the field.