The role of vitamin D in orthopedic surgery

Abstract

Vitamin D status is a critical factor for maintaining musculoskeletal health, and remains an important consideration in patients undergoing orthopedic surgery. While vitamin D deficiency has emerged as a global health issue, the prevalence of vitamin D deficiency is also significant in the orthopedic population. This chapter defines normal vitamin D status as serum 25(OH)D level > 32 ng/ml. Low serum vitamin D levels can be subcategorized to insufficiency and deficiency based on 25(OH) D levels-insufficiency (25(OH)D=20-31 ng/ml) and deficiency (25(OH)D < 20 ng/ml). Following this, the chapter addresses the consequences of low serum vitamin D level in common orthopedic conditions, considering not only how it contributes to the disease process but also how it affects the course of treatment. Under this, it also takes a look at fragility fractures, fracture healing, fracture fixation, and nonunion. Specific to pediatric orthopedics, the chapter addresses rickets and slipped capital femoral epiphysis (SCFE). Additionally, the influence of vitamin D on the progression of osteoarthritis and the longevity of total joint implants are discussed. Lastly, muscle strength and its function are dependent on vitamin D status. Since vitamin D inadequacy can affect various musculoskeletal disorders, orthopedic surgeons should be increasingly aware of the patient's vitamin D status, and become familiar with the strategies for prevention and treatment of vitamin D insufficiency or deficiency. © 2011 Elsevier Inc. All rights reserved.