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Ankle fractures associated with low vitamin D, smoking etc. – Jan 2014

Prevalence of Vitamin D Deficiency in Patients With Foot and Ankle Injuries

Foot & Ankle International January 2014 vol. 35 no. 1 8-13
Jeremy T. Smith, MD1, Kareem Halim, AB1, David A. Palms, AB1, Kanu Okike, MD, MPH2
Eric M. Bluman, MD, PhD1, Christopher P. Chiodo, MD1
1 Brigham Foot and Ankle Center at the Faulkner, Jamaica Plain, MA, USA
2 Department of Orthopaedics, Shock Trauma Center, Baltimore, MD, USA
Jeremy T. Smith, MD, Brigham Foot and Ankle Center at the Faulkner, 1153 Centre Street, Suite 56, Jamaica Plain, MA 02130, USA. Email: jsmith42 at partners.org

Background: Vitamin D deficiency has been identified as one of the most common causes of fragility fractures and poor fracture healing.
Although rates of vitamin D deficiency have been delineated in various orthopaedic populations, little is known about the prevalence of vitamin D deficiency in patients with foot and ankle disorders.
The goal of this study was to identify the prevalence of vitamin D deficiency in patients with a low energy fracture of the foot or ankle.

Methods: Over a 6-month period, a serum 25-OH vitamin D level was obtained from consecutive patients with a low energy ankle fracture, fifth metatarsal base fracture, or stress fracture of the foot or ankle. For comparative purposes, vitamin D levels in patients with an ankle sprain and no fracture were also examined.

Results: The study cohort included 75 patients, of which 21 had an ankle fracture, 23 had a fifth metatarsal base fracture, and 31 had a stress fracture.
The mean age was 52 (range, 16–80) years.

  • Thirty-five of the fracture patients (47%) had an insufficient vitamin D level (below the recommended level of 30 ng/mL), and
  • 10 of the patients (13%) had a level that was deficient (< 20 ng/mL).

Vitamin D levels were significantly lower in those with a fracture than in those with an ankle sprain (P = .02).
In the fracture cohort, the factors significantly associated with vitamin D insufficiency in the multivariate analysis were

  • smoking (P = .03),
  • obesity (P = .003), and
  • other medical risk factors for vitamin D deficiency (P = .03).

Conclusion: Hypovitaminosis D was common among patients with a foot or ankle injury seen at our institution. Patients with a low energy fracture of the foot or ankle were at particular risk for low vitamin D, especially if they smoked, were obese, or had other medical risk factors. Given that supplementation with vitamin D (± calcium) has been shown to reduce the risk of fragility fractures and improve fracture healing, monitoring of 25-OH vitamin D and supplementation should be considered in patients with fractures.

See also VitaminDWiki

Overview Obesity and Vitamin D contains the following summary

Obese need more Vitamin D

  • Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study

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