Effectiveness of Vitamin D Therapy in Orthopaedic Trauma Patients.

Abstract

The purpose of this study was to determine the effectiveness of our vitamin D treatment protocol in managing low serum vitamin D levels in orthopaedic trauma patients. A retrospective review was conducted of all orthopaedic trauma patients at a university level I trauma center over 20 months. Patients were included if they had an initial and repeat 25-hydroxy (OH) vitamin D serum level available. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D level with less than 20 ng/mL. Vitamin D insufficiency was defined as serum 25-hydroxy vitamin D level between 20 and 32 ng/mL. The standard regimen for all patients was over-the-counter vitamin D3 1000 IU and 1500 mg of calcium daily. Patients with vitamin D deficiency or insufficiency also received 50,000 IU of ergocalciferol (D2) weekly until their 25-hydroxyvitamin D level normalized or their fracture healed. No compliance monitoring was performed except for questioning at each clinic visit. A total of 201 patients met the inclusion criteria. Thirty-two patients had a normal initial 25-hydroxyvitamin D level, and 84% maintained their normal level, whereas 16% became insufficient or deficient. There were 88 patients insufficient initially and 54.5% improved to normal and 8% became deficient. In the vitamin D deficiency group (81), 26% remained deficient and 74% improved to insufficient. The average increase in serum 25-OH vitamin D with treatment (in nanograms per milliliter) was statistically significant for both the insufficient and deficient groups. Vitamin D therapy improved the majority of the patients' vitamin D-25-OH level but did not normalize most. Patients with initial deficiency had the largest improvement. This study indicates that vigilance is required to adequately treat a low serum vitamin D-25-OH level.