Osteoporosis International

, Volume 28, Issue 3, pp 1013–1020 | Cite as

Surgery alters parameters of vitamin D status and other laboratory results

  • N. Binkley
  • D. Coursin
  • D. Krueger
  • P. Iglar
  • J. Heiner
  • R. Illgen
  • M. Squire
  • J. Lappe
  • P. Watson
  • K. Hogan
Original Article
First Online:
Received:
Accepted:

Abstract

Summary

Fracture liaison services often perform laboratory testing, but these results may be altered by surgery. In 40 hip arthroplasty patients, many laboratory parameters of bone health relevance were reduced by 8–22% on the first post-operative day. Laboratory results obtained in the immediate post-surgery interval do not reliably ascertain baseline status.

Introduction

As secondary causes of osteoporosis are common, fracture liaison services often perform laboratory testing in the immediate post-fracture interval. We hypothesized that laboratory results obtained shortly after surgery may not accurately ascertain baseline status. If true, such alterations might confound subsequent fracture prevention efforts.

Methods

Patients undergoing elective total hip arthroplasty were studied as a surrogate for hip fracture patients. Blood and urine were obtained 2 weeks before surgery, before anesthetic induction, on post-operative day one, and 6 weeks after surgery. Serum total and free 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), calcium, creatinine, albumin (Alb), alkaline phosphatase (ALP), plasma hemoglobin (Hgb) and urinary DBP/creatinine ratio (UDBP/Cr) were measured.

Results

Forty volunteers (28 women; 12 men) with mean age of 65.7 [8.7] years were studied. Laboratory results were stable from 2 weeks before to the day of surgery. On the first day after surgery, total 25(OH)D, DBP, calcium, creatinine, ALP, and Alb declined 8–22% (p < 0.0001); free 25(OH)D and Hgb declined by 8 and 15% (p < 0.01), respectively; and UDBP/Cr increased 32% (p < 0.01). Using a 25(OH)D <30 ng/mL threshold, vitamin D inadequacy prevalence increased from 38% before surgery to 68% the day after (p < 0.001). All laboratory values returned to baseline at 6 weeks after surgery.

Conclusions

Laboratory values are reduced immediately following elective total hip arthroplasty. Testing at that time does not accurately ascertain baseline status and may lead to elevated estimates of vitamin D inadequacy, incorrect interventions, and misallocation of healthcare resources.

Keywords

Fracture liaison service Hip fracture Laboratory results Vitamin D 
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Notes

Compliance with ethical standards

This study was reviewed and approved by the University of Wisconsin Health Sciences Institutional Review Board.

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.University of Wisconsin Osteoporosis Clinical Research ProgramMadisonUSA
  2. 2.Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of AnesthesiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of Orthopedics and RehabilitationUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.Creighton University Osteoporosis Research CenterOmahaUSA

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