Vitamin D deficiency and impaired growth: Unraveling the key factors and pathways affecting pediatric development

Background: Vitamin D deficiency is a widespread global health concern, particularly affecting children and adolescents during critical periods of growth. This review highlights the multifactorial mechanisms through which vitamin deficiency impairs growth, emphasizing key factors and the effectiveness of interventions. Objective: To explore the impact of vitamin D deficiency on growth in children and adolescents, focusing on disruptions in calcium-phosphorus metabolism, growth plate dynamics, the GH-IGF-1 axis, skeletal deformities, associated conditions, and the effectiveness of treatment strategies. Methods: A comprehensive review of 30 studies published between 2000 and 2024 was conducted to analyze the role of vitamin D deficiency in growth impairment and its correction through various interventions. Results: Vitamin D deficiency significantly disrupts calcium-phosphorus metabolism (25%), impairing bone mineralization and leading to rickets. Growth plate dynamics (20%) are severely affected, with disorganized chondrocyte proliferation and widening of growth plates, delaying bone elongation. The GH-IGF-1 axis (15%) is inhibited, reducing growth velocity. Skeletal deformities (15%), such as bowed legs, compound growth impairment, by altering the mechanical stress on growth plates. Associated conditions (10%), including anemia and chronic diseases, exacerbate growth retardation. High-dose vitamin D regimens improved growth plate structure, IGF-1 levels, and growth outcomes, while supplementation alone was effective for mild to moderate deficiencies. Conclusion: The multifactorial nature of growth impairment in vitamin D deficiency necessitates early diagnosis and a holistic approach. Addressing all contributing factors—such as metabolic disruptions, skeletal deformities, hormonal imbalances, and associated conditions—is essential for optimizing growth and development in children and adolescents. Crucially, timely recognition of vitamin D deficiency enables earlier intervention, which may prevent irreversible growth impairments and support more favorable developmental outcomes. When detected early, vitamin D repletion can restore normal bone metabolism, improve IGF-1 activity, and mitigate the progression of skeletal abnormalities, thereby enhancing overall growth potential during critical periods of development.