Recently I did an interview for Outpatient Surgery Magazine to discuss the results of findings from a study performed at the Hospital for Special Surgery in New York. In the study published in the October 2010 issue of The Journal of Bone and Joint Surgery, Ljiljana Bogunovic et al. present the results of a study in which they reviewed the vitamin-D levels of patients undergoing orthopaedic surgery. The authors reviewed the charts of 723 patients scheduled for orthopaedic surgeries between January 2007 and March 2008. They wanted to determine how prevalent vitamin-D deficiency is among patients undergoing a wide variety of orthopaedic procedures.
The authors reviewed the charts of patients who underwent procedures involving the orthopaedic trauma service, the sports medicine service, the arthroplasty (joint replacement) service, the foot and ankle service, the hand service, and the metabolic bone disease service. An internal medicine physician had cleared all patients in the study for surgery. Since patients with medical conditions that prevented them from having surgery were not included, the results seen here represented seemingly healthy patients.
Among all the patients in this study, 43% were found to have levels of vitamin D there were felt to be insufficient (or less than the value felt to represent normal values – 32 ng/mL). 40% of those were felt to be vitamin D-deficient, meaning they had levels less than 20 ng/mL. When the results were broken down by age, the results were somewhat surprising. Patients between the ages of 51 and 70 were noted to be 35% less at risk for having low vitamin-D levels compared to patients between the ages of 18 and 50. African-Americans and Hispanic patients were more likely to have a low vitamin-D level compared to Caucasians and Asians. Obese patients were twice as likely to have low vitamin-D levels compared to non-obese patients.
As an orthopaedic surgeon specializing in sports medicine, I was most interested in the patients from the sports medicine service at HSS. I’ve always felt that, for the most part, my patients were fairly healthy. In general, sports medicine patients are people that are fairly active, even if they don’t play formal sports. That’s why I was surprised to see that the sports medicine service at HSS had the second-highest prevalence of low vitamin-D levels even though their patients in this study were the youngest. Of the 86 patients from the sports medicine service in this study, who averaged 45 years of age, 52.3% had insufficient levels. One third of those 52.3% had deficient vitamin-D levels.
So what are we supposed to take from this study? It has been shown that vitamin-D deficiency is associated with osteomalacia and altered muscle function. It has been theorized that low vitamin-D levels might impair results of surgical procedures. We know that a large percentage of postmenopausal women with fractures related to osteoporosis have low levels of vitamin D. We don’t fully understand the importance of vitamin-D deficiency among patients undergoing elective surgical procedures. As the authors state, “The purpose of the present study was to raise awareness among orthopaedic surgeons about hypovitaminosis D by presenting compelling but raw data that would spur future in-depth investigations as well as early detection and treatment.”
I think the next step will be to determine if low vitamin-D levels are affected with delayed or inadequate healing from surgery. For instance, is there a higher rate of rotator cuff repair failure among patients with vitamin-D insufficiency? Is there a higher rate of failure or slower return to sports of athletes undergoing ACL reconstruction who have low levels of vitamin D prior to surgery? Should we routinely test for vitamin-D levels in patients undergoing elective orthopaedic procedures? Only time and further research will tell, but this study does shed light on a potentially significant problem along “healthy” patients.
Please click here to read the article in Outpatient Surgery Magazine.