Widespread Vitamin D Deficiency in Patients Undergoing Orthopedic Surgery

Almost half of patients undergoing orthopedic surgery have vitamin D deficiency that should be corrected before surgery to improve patient outcomes, according to a new study.

Researchers at the Hospital for Special Surgery (HSS; New York, NY, USA) conducted a retrospective chart review of 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008. Preoperative serum vitamin D levels were measured. The prevalence of normal (over 32 ng/mL), insufficient (less than 32 ng/mL), and deficient (less than 20 ng/mL) vitamin-D levels was determined. Logistic regression was used to assess risk factors for insufficient levels.

The researchers found that overall, 43% of all patients had insufficient serum vitamin-D levels, and, of these, 40% had deficient levels. Among the orthopedic services, the highest rates of low serum vitamin-D levels were seen in the trauma and sports services, in which the rates of abnormal (insufficient and deficient) vitamin-D levels were 66% and 52%, respectively; the lowest rate of abnormal vitamin-D levels was seen in the metabolic bone disease service. On analysis, patients between the ages of 51-70 years were 35% less likely to have low vitamin-D levels than patients between the ages of 18 and 50 years, and the prevalence of low vitamin-D levels was significantly higher in men. Individuals with darker skin tones (blacks and Hispanics) were 5.5 times more likely to have low vitamin-D levels when compared with those with lighter skin tones (whites and Asians). The study was published in the October 2010 issue of the Journal of Bone and Joint Surgery.

"The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50% of people coming in for orthopedic surgery, and it is eminently correctable,” said lead author Joseph Lane, M.D., a professor of orthopedic surgery and chief of the metabolic bone disease service at HSS. "We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier faster, better, result.”

Vitamin D deficiency has been widely recognized as a common phenomenon, and is caused by many factors. First, it is difficult to get from foods, except products such as cod liver oil and fish. Also, until recently, the recommended daily allowance was set too low, causing foods to not be supplemented with adequate doses. Thirdly, while vitamin D can be generated from sunlight, people often work long hours indoors, and often use sunscreen that impedes vitamin D intake when they do venture into sunlight.

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