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Orthopedic Trauma Patients Most Often Low in Vitamin D

Orthopedic Trauma Patients Most Often Low in Vitamin D

Vitamin D deficiency and insufficiency may be more common than you think, particularly in patients with fractures, shows a retrospective review published in the American Journal of Orthopedics.

According to the review, the overall prevalence of deficiency and insufficiency is 77 percent as compared to 39 percent of patients who suffer from deficiency alone, wrote Michael A. Hood, M.D., and colleagues in the November issue of the journal.

Vitamin D deficiency is a well know contributing factor in diabetes, cancer and cardiovascular disease. The authors point out that other studies have shown strong correlations between vitamin D deficiency, muscle weakness, fragility fractures and fracture nonunion. And while this deficiency typically affects the elderly, more and more younger people are presenting with the same reductions in vitamin D.

Dr. Hood and colleagues sought to investigate the incidence of deficient or low vitamin D levels in a sample of 889 patients (487 female, 402 male, mean age 53.8 years) who were treated at a trauma center for acute fractures between January 2009 and September 2010.

“Despite the detrimental effects of vitamin D deficiency on musculoskeletal and general health, evidence exists that vitamin D deficiency is surprisingly prevalent. This deficiency is known to be associated with increasing age, but recent studies have also found alarming rates of deficiency in younger populations,” the authors wrote.

In this review, a vitamin D deficiency was defined as a 25-hydroxyvitamin D level of 20 ng/mL or less and insufficiency as 21 to 32 ng/mL.

With no significant age or sex differences noted, 77.39 percent of subjects met criteria for deficiency or insufficiency while 39.03 percent satisfied criteria for deficiency by itself. This compares to a previous six-month study of 44 fractures in which a 60 percent rate of deficiency and insufficiency were found.

Young patients had the lowest prevalence of deficiency and insufficiency (29.1 percent and 54.7 percent respectively). However, when compared to patients 36 to 65 years old, the difference did not reach statistical significance (P=0.25).

Women between 18 to 25 years old had a lower, albeit insignificant rates of deficiency (25 percent; p=0.41) and insufficiency (41.7 percent; p=0.16) when compared to older women. Men between 18 to 25 years old saw similar reductions in prevalence to their older counterparts (59.7 percent; p=0.24). But other studies have identified low vitamin D levels in young people— as much as 52 percent among black and Hispanic adolescents one study showed.

The authors cited various other studies in which 60 to 90 percent of patients treated for hip fractures were deficient or insufficient in vitamin D.

Clinicians should consider treating low vitamin D levels in patients both before and after a fracture.

“Establishing the prevalence of hypovitaminosis D in orthopedic trauma patients is needed in order to raise awareness of the disease and modify screening and treatment protocols. Brinker and O’Connor found vitamin D deficiency in 68% of patients with fracture nonunions, which suggests that hypovitaminosis D may partly account for difficulty in achieving fracture union. Bogunovic and colleagues found vitamin D insufficiency in 43% of 723 patients who underwent orthopedic surgery,” the authors wrote.

No seasonal differences were found in this study.

The authors point out the retrospective nature of the study and possible selection bias as potential limitations of the study.

 

References

Hood MA, Murtha YM, Della Rocca GJ, et al. “Prevalence of low vitamin D levels in patients with orthopedic trauma,” American Journal of Orthopedics. November 2016. 45(7):E522-E526

 

 
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