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@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.

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See also VitaminDWiki

• Search VitaminDWiki for ANKLE 192 items as of Jan 2018
• Ankle strength and vitamin D lowest in winter, and were associated with more elderly falls – May 2012
• Foot and Ankle Fracture Healing – vitamin D appears promising for everyone– review May 2015
• Ankle sprains evolving to OLT (Talus bone pain) are associated with low vitamin D – Jan 2018
• Overview Fractures and Falls and Vitamin D
• Smoking reduces vitamin D - many studies

Overview Obesity and Vitamin D contains the following summary

• FACT: People who are obese have less vitamin D in their blood
• FACT: Obese need a higher dose of vitamin D to get to the same level of vit D
• FACT: When obese people lose weight the vitamin D level in their blood increases
• FACT: Adding Calcium, perhaps in the form of fortified milk, often reduces weight
• FACT: 168 trials for vitamin D intervention of obesity as of Dec 2021
• FACT: Less weight gain by senior women with > 30 ng of vitamin D
• FACT: Dieters lost additional 5 lbs if vitamin D supplementation got them above 32 ng - RCT
• FACT: Obese lost 3X more weight by adding $10 of Vitamin D
• FACT: Those with darker skins were more likely to be obese Sept 2014
• OBSERVATION: Low Vitamin D while pregnancy ==> more obese child and adult
• OBSERVATION: Many mammals had evolved to add fat and vitamin D in the autumn
  • and lose both in the Spring - unfortunately humans have forgotten to lose the fat in the Spring
• SPECULATION: Low vitamin D might be one of the causes of obesity – several studies
• SUGGESTION: Probably need more than 4,000 IU to lose weight if very low on vitamin D due to
    risk factors such as overweight, age, dark skin, live far from equator,shut-in, etc.
• Obesity category has 442 items

See also: Weight loss and Vitamin D - many studies   Child Obesity and Vitamin D - many studies   Obesity, Virus, and Vitamin D - many studies
Obese need more Vitamin D

• Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study