Prospective Nutritional Analysis of a Diverse Trauma Population Demonstrates Substantial Hypovitaminosis D.
J Orthop Trauma. 2014 Jan 23.
Zellner BS, Dawson JR, Reichel LM, Schaefer K, Britt J, Hillin C, Reitman CA.
Baylor College of Medicine Department of Orthopedic Surgery, Ben Taub General Hospital, Houston, Texas.
OBJECTIVES:There are several metabolic factors known to be important for the maintenance of bone and muscle function. Causes of deficiency are multifactorial and can include such things as geographic region, latitude and socioeconomic factors. The purpose of this study was to determine the prevalence of metabolic deficiencies.
SETTING:Level 1, urban trauma center
DESIGN: Prospective laboratory evaluation
PATIENTS: 652 consecutive admits to the orthopaedic surgery service between July 1, 2011 and June 30, 2012
INTERVENTION: Laboratory evaluation
MAIN OUTCOME MEASUREMENTS: Metabolic and endocrine profiles included a serum analysis on all patients. Subject data included age, gender, body mass index, month of admission, and type of injury as well as subjects self-reported race, alcohol, recreational drug, and tobacco use were collected.
RESULTS:652 subjects with an average age of 41.2 years were evaluated. After data analysis, only 25-Hydroxyvitamin D levels were found to be persistently poor across the patient population.
- 86.2% of subjects were insufficient in 25-Hydroxyvitamin D (<30ng/mL),
- 53.2% were deficient (<20ng/mL), and
- 14.0% had levels <10 ng/mL (severely deficient).
76.7% of the subjects increased skin pigmentation, and the differences in 25-Hydroxyvitamin D levels between races were significantly different. African Americans had the highest risk of severe deficiency. 25-Hydroxyvitamin D levels were significantly higher during summer months, with males, and with a lower BMI, but there were no differences based on age or substance use. Additional lab analysis did not reveal significant nutritional deficiency.
CONCLUSION: The prevalence of hypovitaminosis D is widespread. This may negatively affect outcomes for orthopedic patients but would be easily correctable. 25-Hydroxyvitamin D serologic analysis should be considered for all orthopedic trauma patients.
LEVEL OF EVIDENCE: Prognostic Level IV.