Almost 50 percent of patients undergoing orthopedic surgery have vitamin D deficiency that should be corrected before surgery to improve patient outcomes, based on a study by researchers at Hospital for Special Surgery (HSS) in New York City. Vitamin D is essential for bone healing and muscle function and is critical for a patient's recovery. The study appears in the October issue of The Journal of Bone and Joint Surgery.
"In the perfect world, test levels, fix and then operate," said Joseph Lane, M.D., professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at HSS, who led the study. "If you put people on 2,000-4,000 [milligrams] of vitamin D based on what their deficient value was, you can usually get them corrected in four to six weeks, which is when you are really going to need the vitamin D. If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it."
According to Dr. Lane, bone remodeling or bone tissue formation, a part of the healing process, occurs about two to four weeks after surgery. This is the critical stage when your body needs vitamin D.
For their study, investigators conducted a retrospective chart review of 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008 at HSS. They examined the vitamin D levels, which had been measured in all patients before their surgery, and found that 43 percent had insufficient vitamin D and 40 percent had deficient levels.
Vitamin D inadequacy was defined as <32 ng/mL, vitamin D insufficiency was defined as 20 to <32 ng/mL, and vitamin D deficiency was defined at <20 ng/mL. Problems were more prevalent in younger patients, men and individuals with dark skin—blacks and Hispanic.
The highest levels of deficiency were seen in patients in the trauma service, where 66 percent of patients had insufficient levels and 52 percent had deficient levels. Of the patients undergoing foot and ankle surgery, 34 percent had inadequate levels and of patients undergoing hand surgery, 40 percent had insufficient levels.
In the Sports Medicine Service, 52.3 percent had insufficient levels and of these, one-third of these or 17 percent of the total had deficient levels. "We frequently see stress fractures in the Sports Medicine Service and if you want to heal, you have to fix the calcium and vitamin D," Dr. Lane said.