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


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.

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We would like at acknowledge the following financial contributions that helped support this research:

Cohn Foundation

Diane Wolf

Musculoskeletal Repair and Regeneration Core Center, Grant AR046121

Hospital for Special Surgery orthopedic surgery medical student support

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Correspondence to Barbara Steele MD.

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Level of evidence: level IV

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Steele, B., Serota, A., Helfet, D.L. et al. Vitamin D Deficiency: A Common Occurrence in Both High-and Low-energy Fractures. HSS Jrnl 4, 143–148 (2008).

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