Advances in the relationship between vitamin D and post-traumatic  bone loss in children and adolescents

ZHANG Jinlong; ZHOU Hongyan; ZHAO Hongbo; LI Junran; WU Yiheng

doi:10.11852/zgetbjzz2025-0377

PDF(621 KB)

Chinese Journal of Child Health Care ›› 2026, Vol. 34 ›› Issue (4) : 460-464. DOI: 10.11852/zgetbjzz2025-0377

Review

Advances in the relationship between vitamin D and post-traumatic bone loss in children and adolescents

ZHANG Jinlong^1,2, ZHOU Hongyan², ZHAO Hongbo², LI Junran², WU Yiheng^1,2

Author information +

History +

Abstract

Post-traumatic bone loss is an under-recognized complication following fractures in children and adolescents, which may compromise peak bone mass and increase the long-term risk of refracture.As a key regulator of bone-muscle health, vitamin D may contribute to post-traumatic bone loss through multiple pathways, including modulation of calcium-phosphate metabolism, immune and inflammatory responses, and musculoskeletal mechanical loading.Available clinical evidence suggests that vitamin D deficiency/insufficiency is prevalent among pediatric fracture patients and is associated with reduced bone mineral density, increased refracture risk, and delayed fracture healing.Focusing on mechanisms such as inflammation, reduced disuse-related mechanical stimulation, and parathyroid hormone dysregulation, this review systematically summarizes the association between vitamin D and post-traumatic bone loss in children and adolescents and its potential interventional value, and discusses practical considerations for vitamin D supplementation in clinical practice.Further multicenter prospective studies and randomized controlled trials are warranted to determine the optimal timing, dosage, and monitoring strategy for post-injury vitamin D supplementation.

Key words

vitamin D / post-traumatic bone loss / bone mineral density / fracture risk / fracture healing / children and adolescents

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

ZHANG Jinlong, ZHOU Hongyan, ZHAO Hongbo, LI Junran, WU Yiheng. Advances in the relationship between vitamin D and post-traumatic bone loss in children and adolescents[J]. Chinese Journal of Child Health Care. 2026, 34(4): 460-464 https://doi.org/10.11852/zgetbjzz2025-0377

References

[1] Osipov B, Emami AJ, Christiansen BA.Systemic bone loss after fracture[J].Clin Rev Bone Miner Metab, 2018, 16(4): 116-130.
[2] 孟斌, 程黎明, 海涌, 等.骨科急性骨丢失防治专家共识[J].中华骨与关节外科杂志, 2021, 14(7): 577-583.
Meng B, Cheng LM, Hai Y, et al.Expert consensus on prevention and treatment of acute bone loss in orthopaedics[J].Chin J Bone Joint Surg, 2021, 14(7): 577-583.(in Chinese)
[3] Chevalley T, Rizzoli R.Acquisition of peak bone mass[J].Best Pract Res Clin Endocrinol Metab, 2022, 36(2): 101616.
[4] Bikle D, Christakos S.New aspects of vitamin D metabolism and action-addressing the skin as source and target[J].Nat Rev Endocrinol, 2020, 16(4): 234-252.
[5] 中国营养学会健康管理分会.维生素D营养状况评价及改善专家共识[J].中华健康管理学杂志, 2023, 17(4): 245-252.
Health Management Branch of Chinese Nutrition Society.Expert consensus on evaluation and improvement of vitamin D nutritional status[J].Chin J Health Manage, 2023, 17(4): 245-252.(in Chinese)
[6] Crescioli C.Vitamin D restores skeletal muscle cell remodeling and myogenic program: Potential impact on human health[J].Int J Mol Sci, 2021, 22(4): 1760.
[7] 安娜, 赵宜乐, 张古英, 等.2010—2020年中国健康儿童维生素D水平的Meta分析[J].中国儿童保健杂志, 2021, 29(10): 1109-1114.
An N, Zhao YL, Zhang GY, et al.Meta-analysis of vitamin D level in healthy Chinese children over the past 10 years[J].Chin J Child Health Care, 2021, 29(10): 1109-1114.(in Chinese)
[8] Bouillon R, Antonio L, Narinx N.Vitamin D status in children[J].J Pediatr (Rio J), 2024, 100(4): 335-339.
[9] Liu T, Wang E, Li Q, et al.High prevalence of vitamin D insufficiency in Chinese children with upper limb fractures[J].Genes Dis, 2019, 7(3):408-413.
[10] Hosseinzadeh P, Mohseni M, Minaie A, et al.Vitamin D status in children with forearm fractures: Incidence and risk factors[J].J Am Acad Orthop Surg Glob Res Rev, 2020, 4(8): e20.00150-e20.155.
[11] Siddiqui AA, Kumar J, Adeel M, et al.Prevalence of vitamin D deficiency in children presenting with supracondylar fractures of humerus[J].Int J Clin Pract, 2021, 75(5): e14056.
[12] Ergün T, Cansever M.Comparison of 25-OH vitamin D levels between children with upper and those with lower extremity fractures: A prospective case-control study[J].Acta Orthop Traumatol Turc, 2022, 56(2): 76-80.
[13] Moore DM, O′Sullivan M, Kiely P, et al.Vitamin D levels in Irish children with fractures: A prospective case-control study with 5 year follow-up[J].Surgeon, 2022, 20(2): 71-77.
[14] Lee YS, Lee SU, Hong TM, et al.Prevalence of vitamin D deficiency in children with fractures: Before and during the COVID-19 outbreak[J].Int J Clin Pract, 2022, 2022: 4410032.
[15] Muzzammil M, Minhas MS, Mughal A, et al.Prevalence of inadequate vitamin D level and its predictors in children presenting with torus fractures[J].Eur J Orthop Surg Traumatol, 2023, 33(5): 1767-1772.
[16] Segal D, Ziv A, Meisman A, et al.Relationship between hypovitaminosis D and fractures among adolescents with overweight or obesity[J].Clin Pediatr (Phila), 2023, 62(2): 107-114.
[17] Karkenny AJ, Avarello J, Hanstein R, et al.Pediatric fractures: Does vitamin D play a role?[J].J Pediatr Orthop, 2023, 43(8): 492-497.
[18] Assaf E, Nicolas G, Hoyek F, et al.Vitamin D level and low-energy fracture risk in children and adolescents: A population-based case-control study of 45 cases[J].J Pediatr Orthop B, 2024, 33(4): 392-398.
[19] Kreienbuehl AS, Rogler G, Emanuel B, et al.Bone health in patients with inflammatory bowel disease[J].Swiss Med Wkly, 2024, 154: 3407.
[20] Yoshida S, Ikedo A, Yanagihara Y, et al.Bub1 suppresses inflammatory arthritis-associated bone loss in mice through inhibition of TNF α-mediated osteoclastogenesis[J].J Bone Miner Res, 2024, 39(3): 341-356.
[21] Sırbe C, Rednic S, Grama A, et al.An Update on the effects of vitamin D on the immune system and autoimmune diseases[J].Int J Mol Sci, 2022, 23(17): 9784.
[22] Redlich K, Smolen JS.Inflammatory bone loss: Pathogenesis and therapeutic intervention[J].Nat Rev Drug Discov, 2012, 11(3): 234-250.
[23] Osipov B, Paralkar MP, Emami AJ, et al.Sex differences in systemic bone and muscle loss following femur fracture in mice[J].J Orthop Res, 2022, 40(4): 878-890.
[24] Zheng XQ, Huang J, Lin JL, et al.Pathophysiological mechanism of acute bone loss after fracture[J].J Adv Res, 2023, 49: 63-80.
[25] Qin L, Liu W, Cao H, et al.Molecular mechanosensors in osteocytes[J].Bone Res, 2020, 8: 23.
[26] Wang L, You X, Zhang L, et al.Mechanical regulation of bone remodeling[J].Bone Res, 2022, 10(1): 16.
[27] Ceroni D, Martin X, Kherad O, et al.Factors affecting bone mineral mass loss after lower-limb fractures in a pediatric population[J].J Pediatr Orthop, 2015, 35(4): 345-351.
[28] Maggio ABR, Martin X, Tabard-Fougère A, et al.Reco-very of bone mineral mass after upper limb fractures in children and teenagers[J].J Pediatr Orthop, 2019, 39(4): e248-e252.
[29] 郑小平, 卑明健, 吴新宝.骨折后急性骨丢失的研究进展[J].骨科临床与研究杂志, 2023, 8(6): 386-388.
[30] Ladang A, Rousselle O, Huyghebaert L, et al.Parathormone, bone alkaline phosphatase and 25-hydroxyvitamin D status in a large cohort of 1200 children and teenagers[J].Acta Clin Belg, 2022, 77(1): 4-9.
[31] Kralick AE, Zemel BS.Evolutionary perspectives on the developing skeleton and implications for lifelong health[J].Front Endocrinol (Lausanne), 2020, 11: 99.
[32] Zhu X, Zheng H.Factors influencing peak bone mass gain[J].Front Med, 2021, 15(1): 53-69.
[33] Simões D, Craveiro V, Santos MP, et al.The effect of impact exercise on bone mineral density: A longitudinal study on non-athlete adolescents[J].Bone, 2021, 153: 116151.
[34] Lee JH, Ha AW, Kim WK, et al.The combined effects of milk intake and physical activity on bone mineral density in Korean adolescents[J].Nutrients, 2021, 13(3): 731.
[35] Constable AM, Vlachopoulos D, Barker AR, et al.The independent and interactive associations of physical activity intensity and vitamin D status with bone mineral density in prepubertal children: The PANIC Study[J].Osteoporos Int, 2021, 32(8): 1609-1620.
[36] Xiong T, Wu Y, Li Y, et al.Association of serum 25-hydroxyvitamin D with bone health measured by calcaneal quantitative ultrasound: A large cross-sectional analysis in children and adolescents[J].Food Funct, 2024, 15(3): 1379-1389.
[37] Pan K, Tu R, Yao X, et al.Associations between serum calcium, 25(OH)D level and bone mineral density in adolescents[J].Adv Rheumatol, 2021, 61(1): 16.
[38] Nørgaard SM, Dalgård C, Heidemann MS, et al.Bone mineral density at age 7 years does not associate with adherence to vitamin D supplementation guidelines in infancy or vitamin D status in pregnancy and childhood: An Odense Child Cohort study[J].Br J Nutr, 2021, 126(10): 1466-1477.
[39] Moon RJ, Citeroni NL, Aihie RR, et al.Early life programming of skeletal health[J].Curr Osteoporos Rep, 2023, 21(4): 433-446.
[40] Kanis JA, Johansson H, McCloskey EV, et al.Previous fracture and subsequent fracture risk: A meta-analysis to update FRAX[J].Osteoporos Int, 2023, 34(12): 2027-2045.
[41] 王凯韬, 王建伟.急性骨丢失与骨质疏松症的关系研究进展[J].现代医药卫生, 2024, 40(12): 2114-2117.
Wang KT, Wang JW.Research progress on the relationship between acute bone loss and osteoporosis[J].J Mod Med Health, 2024, 40(12): 2114-2117.(in Chinese)
[42] Verna C.Regional acceleratory phenomenon[J].Front Oral Biol, 2016, 18: 28-35.
[43] Herdea A, Ionescu A, Dragomirescu MC, et al.Vitamin D-A risk factor for bone fractures in children: A population-based prospective case-control randomized cross-sectional study[J].Int J Environ Res Public Health, 2023, 20(4): 3300.
[44] Hendrych J, Bayer M, Havránek P, et al.Vitamin D levels during fracture healing in children[J].Physiol Res, 2024, 73(6): 1063-1074.
[45] Demay MB, Pittas AG, Bikle DD, et al.Vitamin D for the prevention of disease: An endocrine society clinical practice guideline[J].J Clin Endocrinol Metab, 2024, 109(8): 1907-1947.
[46] Klein G, 赵燕玲, 杜建, 等.儿童骨丢失风险因素与管理对策[J].中华健康管理学杂志, 2010, 4(5): 306-308.