Vitamin D

Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: a single-center analysis.

Ljiljana Bogunovic, Abraham D Kim, Brandon S Beamer, Joseph Nguyen, Joseph M Lane. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.

Almost 50% of patients undergoing orthopaedic surgery have a Vitamin D deficiency that should be correct BEFORE surgery.

BACKGROUND: Vitamin D is essential for optimal bone health and muscle function. An alarmingly high rate of vitamin-D deficiency in the general population has been reported recently. The purpose of the present study was to characterise the extent of low serum levels of vitamin D among orthopaedic surgery patients.

RESULTS: Overall, 43% of all patients had insufficient serum vitamin-D levels, and, of these, 40% had deficient levels. Among the orthopaedic services, the highest rates of low serum vitamin-D levels were seen in the trauma and sports services, in which the rates of abnormal (insufficient and deficient) vitamin-D levels were 66% and 52%, respectively. The lowest rate of abnormal vitamin-D levels was seen in the metabolic bone disease service. Patients between the ages of fifty-one and seventy years were 35% less likely to have low vitamin-D levels than patients between the ages of eighteen and fifty years (p = 0.018). The prevalence of low vitamin-D levels was significantly higher in men (p = 0.006). Individuals with darker skin tones (blacks and Hispanics) were 5.5 times more likely to have low vitamin-D levels when compared with those with lighter skin tones (whites and Asians) (p < 0.001)

CONCLUSIONS: The prevalence of low serum levels of vitamin D among patients undergoing orthopaedic surgery is very common. Given the importance of vitamin D in musculoskeletal health, such low levels may negatively impact patient outcomes.

• There are no unreasonable risks from intake of 2000 iu per day of vitamin D3 or from a population blood serum 25(OH)D level of 40 - 60 ng/mL (Ann Epidemiol 2009;19:468-483)
  
  • Of approximately 3000 research studies published investigating the inverse relationship between vitamin D and cancer, most of the epidemiological studies have reported that higher vitamin D (25(OH)D) levels show lower incidence of various cancers and aggressive prostate cancers.
• Women with higher UVB sun exposure had half the incidence of breast cancer than those with a lower exposure.
• In another study with men the same was found but with half the incidence of fatal prostate cancer. (The sun activates vitamin D in the skin, so this basically means more sun, higher vitamin D and lower breast cancer rates - comment by Christian Bates)
• Almost all lab studies using tissue culture systems have reported inhibition of growth of malignant cells (cancer cells) and many have identified a re-differentation in response to different vitamin D's (Christian - cells becoming less malignant).

• Breast cancer patients with levels of 25(OH)D higher than 29 ng/mL at diagnosis had a 42% lower 15 year death rate than those with less than 20 ng/mL. Also incidence of metastases was half as high with the same level range.
• Another study found lower fatality rates in patients with breast, colon, prostate and lung cancer who were diagnosed in the Summer when blood vitamin D levels were highest due to sun conversion.