HSS Journal

, Volume 4, Issue 2, pp 143–148 | Cite as

Vitamin D Deficiency: A Common Occurrence in Both High-and Low-energy Fractures

  • Barbara Steele
  • Alana Serota
  • David L. Helfet
  • Margaret Peterson
  • Stephen Lyman
  • Joseph M. Lane
Original Article


As a consequence of newly elevated standards for normal vitamin D levels, there is a renewed interest in vitamin D insufficiency and deficiency (<32 and <20 ng/ml, respectively) in the orthopedic patient population. This study tests the hypothesis that vitamin D insufficiency is comparably prevalent among both high- and low-energy fracture patients. A retrospective analysis of the medical records for 44 orthopedic trauma in-patients with non-vertebral fractures was conducted from June 1, 2006 to February 1, 2007. The obtained data included a 25-hydroxyvitamin D level, age, gender, and reason for admission; high-energy vs. low-energy fracture. Vitamin D insufficiency, 25(OH)D <32 ng/ml, was found in 59.1% of the patients. Significantly, more women (75%) than men (40%) were vitamin D insufficient among all fracture patients and specifically among high-energy fractures, 80% women insufficient vs. 25% men insufficient. In women, both high- and low-energy fractures present with vitamin D insufficiency (80% of high-energy fractures and 71.4% of low-energy fractures). In men, the mean vitamin D level was lower for low-energy fractures (16 ng/ml) compared to high-energy fractures (32 ng/ml). In addition, men with low-energy fractures were significantly older than men with high-energy fractures and women with low-energy fractures were also older. Statistically, more vitamin D insufficiency is seen in women and our results are consistent with the gender difference seen in the general population. Even among younger men who sustain a high-energy fracture, 25% are vitamin D insufficient. Women with fractures regardless of age or fracture energy level have low vitamin D levels. Levels of 25(OH)D should be measured in all orthopedic trauma patients and the American Society for Bone and Mineral Research and National Osteoporosis Foundation currently recommend that vitamin D levels should be corrected.


vitamin D 25(OH)D fracture vitamin D insufficiency vitamin D deficiency 


  1. 1.
    Becker C, Crow S, Toman J et al (2006) Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17:410–416PubMedCrossRefGoogle Scholar
  2. 2.
    Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999–2006PubMedCrossRefGoogle Scholar
  3. 3.
    Boonen S, Rizzoli R, Meunier PJ et al (2004) The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report. Osteoporos Int 15:511–519PubMedCrossRefGoogle Scholar
  4. 4.
    Chapuy MC, Preziosi P, Maamer M et al (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443PubMedCrossRefGoogle Scholar
  5. 5.
    Dukas L, Staehelin HB, Schacht E et al (2005) Better functional mobility in community-dwelling elderly is related to D-hormone serum levels and to daily calcium intake. J Nutr Health Aging 9(5):347–351PubMedGoogle Scholar
  6. 6.
    Glerup H, Mikkelsen K, Poulsen L et al (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66:419–424PubMedCrossRefGoogle Scholar
  7. 7.
    Glowacki J, Hurwitz S, Thornhill TS et al (2003) Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Jt Surg Am 85:2371–2377Google Scholar
  8. 8.
    Heaney RP (2003) Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 78:912–919PubMedGoogle Scholar
  9. 9.
    Holick MS (2005) The vitamin D epidemic and its health consequences. J Nutr 135(11):2739S–2748SPubMedGoogle Scholar
  10. 10.
    Janssen H, Samson MM, Verhaar HJ (2002) Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 75(4):611–615PubMedGoogle Scholar
  11. 11.
    Larsen ER, Mosekilde L, Foldspang A (2004) Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 19(3):370–378PubMedCrossRefGoogle Scholar
  12. 12.
    LeBoff MS, Kohlmeier L, Hurwitz S et al (1999) Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 281(16):1505–1511PubMedCrossRefGoogle Scholar
  13. 13.
    Lips P (2006) Vitamin D physiology. Prog Biophys Mol Biol 92(1):4–8PubMedCrossRefGoogle Scholar
  14. 14.
    Lips P, Hosking D, Lippuner K et al (2006) The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med 260:245–254PubMedCrossRefGoogle Scholar
  15. 15.
    Malabanan A, Holick MF (2003) Vitamin D and bone health in postmenopausal women. J Women’s Health 12(2):151–156CrossRefGoogle Scholar
  16. 16.
    Malabanan A, Veronikis E, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806PubMedCrossRefGoogle Scholar
  17. 17.
    Mizunuma H, Shiraki M, Shintani M et al (2006) Randomized trial comparing low-dose hormone replacement therapy and HRT plus 1a-OH-vitamin D3 (alfacalcidol) for treatment of postmenopausal bone loss. J Bone Miner Metab 24:11–15PubMedCrossRefGoogle Scholar
  18. 18.
    Mosekilde L (2005) Vitamin D and the elderly. Clin Endocrinol 62:265–281CrossRefGoogle Scholar
  19. 19.
    Mowé M, Haug E, Bøhmer T (1999) Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 47:220–226PubMedGoogle Scholar
  20. 20.
    Nieves JW (2004) Calcium and vitamin D: current developments in the prevention of osteoporosis and osteomalacia. Curr Opin Orthop 15(5):383–388CrossRefGoogle Scholar
  21. 21.
    Passeri G, Pini G, Troiano L et al (2003) Low vitamin D status, high bone turnover, and bone fractures in centenarians. J Clin Endocrinol Metab 88(11):4109–5115CrossRefGoogle Scholar
  22. 22.
    Sakuma M, Endo N, Oinuma T et al (2006) Vitamin D and intact PTH status in patients with hip fracture. Osteoporos Int 17:1608–1614PubMedCrossRefGoogle Scholar
  23. 23.
    Tangpricha V, Pearce EN, Chen TC et al (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112(8):659–662PubMedCrossRefGoogle Scholar
  24. 24.
    Thomas MK (1998) Hypovitaminosis D in hospital inpatients. N Engl J Med 338(12):777–783PubMedCrossRefGoogle Scholar
  25. 25.
    Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomized double blind controlled trial. BMJ 326:469–474PubMedCrossRefGoogle Scholar
  26. 26.
    Utiger RD (1998) Editorial. The need for more vitamin D. N Engl J Med 338(12):828–829PubMedCrossRefGoogle Scholar
  27. 27.
    Willis M (2002) The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden. Int J Technol Assess Health Care 18(4):791–807PubMedCrossRefGoogle Scholar
  28. 28.
    Zadshir A, Tareen N, Pan D et al (2005) The prevalence of hypovitaminosis D among US adults. Data from the NHANES III. Ethn Dis 15(Suppl 5):97–101Google Scholar
  29. 29.
    Zittermann A (2003) Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr 89:552–572PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2008

Authors and Affiliations

  • Barbara Steele
    • 1
  • Alana Serota
    • 1
  • David L. Helfet
    • 1
  • Margaret Peterson
    • 1
  • Stephen Lyman
    • 1
  • Joseph M. Lane
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA

Personalised recommendations