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Acute fracture patients – 70 percent were vitamin D deficient – meta-analysis Sept 2015

What is the role of vitamin D supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis D and supplementation efficacy.

J Orthop Trauma. 2015 Sep 22. [Epub ahead of print]
Sprague S1, Petrisor B, Scott T, Devji T, Phillips M, Spurr H, Bhandari M, Slobogean G.
1Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario
2Department of Clinical Epidemiology and Biostatistics, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario
3Graduate Entry Medicine, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
4Department of Orthopaedics, University of Maryland School of Medicine, 6th Floor, Suite 300, 110 S. Paca St., Baltimore MD.

OBJECTIVES: The objectives of this systematic review and meta-analyses are: 1) to estimate the prevalence of hypovitaminosis D in fracture patients and 2) to summarize the available evidence on the efficacy of vitamin D supplementation in fracture patients.

DATA SOURCES: A comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases was conducted. Conference abstracts from relevant meetings were also searched.

STUDY SELECTION: We included studies that investigate vitamin D insufficiency or examine the effect of vitamin D supplementation on 25(OH)D serum levels in fracture patients.

DATA EXTRACTION: Two authors independently extracted data using a pre-designed form.

DATA SYNTHESIS: We performed a pooled analysis to determine the prevalence of post-fracture hypovitaminosis D and mean post-fracture 25(OH)D levels. We present detailed summaries of each of the studies evaluating the impact of vitamin D supplementation.

RESULTS: The weighted pooled prevalence of hypovitaminosis D was 70.0% (95% CI: 63.7-76.0%, I = 97.7).
The mean post-fracture serum 25(OH)D was 19.5 ng/ml. The studies that evaluated the efficacy of vitamin D supplementation suggest that vitamin D supplementation safely increases serum 25(OH)D levels. Only one meeting abstract showed a trend towards reduced risk of nonunion following a single large loading dose of vitamin D.

CONCLUSIONS: This review found a high prevalence of hypovitaminosis D in fracture patients and that vitamin D supplementation at a range of doses safely increases 25(OHD) serum levels. To date, only one pilot study published as a meeting abstract has demonstrated a trend towards improved fracture healing with vitamin D supplementation.


PMID: 26429406

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