Critical Care Medicine. 46(1):771, JAN 2018, DOI: 10.1097/01.ccm.0000529574.73800.e2
Serena Harris; Thernell Anderson
- Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018
- Nonunion after elective foot or ankle reconstruction 8 times more likely if low vitamin D – May 2017
- Give Vitamin D to all fracture patients – cost effective to prevent nonunions – Aug 2016
- Death of older hip fracture patients at least 1.6X more likely if low vitamin D – May 2018
Learning Objectives: Vitamin D deficiency is a chronic and multifactorial problem in the general population due to its many contributing risk factors including age, obesity, and malnutrition. Among trauma patients with fractures, low vitamin D levels have shown to correlate with a higher rate of fracture nonunion which can result in long-term complications and need for additional surgeries.
Methods: Adult trauma patients with a baseline serum 25-hydroxy (OH) vitamin D level were retrospectively identified between 2/1/15 through 5/31/16. The primary objectives were to determine the prevalence of vitamin D deficiency among trauma patients with fractures and assess the incidence of fracture nonunion in vitamin D deficient patients treated with vitamin D supplementation.
Results: Eighty one patients were included. Patients were divided into three groups based on the initial 25-OH vitamin D level. All patients had vitamin D deficiency with an initial vitamin D level of 21–30 ng/mL (n = 9), 10–20 ng/mL (n = 32), and < 10 ng/mL (n = 40). There were no differences in age (p = 0.517), body mass index (p = 0.869), or other baseline characteristics between groups. No difference in nonunion was observed based on the degree of vitamin D deficiency 21–30 ng/mL (n = 1), 10–20 ng/mL (n = 1), < 10 ng/mL (n = 4), p = 0.3797.
A difference in initial vitamin D level (23.5 vs. 14.4 vs. 5, p < 0.001) and duration of treatment (6 vs. 6 vs. 8 wks, p < 0.001) was observed between groups. There were no reports of vitamin D toxicity based on the treatment protocol.
Conclusions: In this pilot study, the prevalence of vitamin D deficiency was high in trauma patients with most having an initial 25-OH vitamin D level < 10 ng/mL. The highest rate of nonunion was observed in patients with a 25-OH vitamin D level < 10 ng/mL.