Prospective nutritional analysis of a diverse trauma population demonstrates substantial hypovitaminosis D

J Orthop Trauma. 2014 Sep;28(9):e210-5. doi: 10.1097/BOT.0000000000000053.

Abstract

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: The subjects included 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, and subjects' self-reported race, alcohol, recreational drug, and tobacco use were collected.

Results: Six hundred fifty-two 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 (<30 ng/mL), 53.2% were deficient (<20 ng/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 men, and with a lower body mass index, but there were no differences based on age or substance use. Additional laboratory analysis did not reveal significant nutritional deficiency.

Conclusions: The prevalence of hypovitaminosis D is widespread. This may negatively affect outcomes for orthopaedic patients but would be easily correctable. 25-Hydroxyvitamin D serologic analysis should be considered for all orthopaedic trauma patients.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Calcium / blood
  • Comorbidity
  • Female
  • Humans
  • Male
  • Prevalence
  • Trauma Centers
  • Urban Population
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / epidemiology*
  • Vitamin D Deficiency / ethnology
  • Wounds and Injuries / blood
  • Wounds and Injuries / epidemiology*

Substances

  • Calcium