Vitamin D levels in ununited fractures.
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Published:
Aug 6, 2016
Keywords:
Vitamin-D, nonunion, vitamin-D deficiency
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Abstract
Introduction: Absence of bone union after a fracture is generally multifactorial.Objective: To determine reference vitamin-D values (25 OH D3) in nonunions, and study its association with age and localization.Methods: A prospective, observational and descriptive study was performed, in which 29 patients with fracture nonunions were evaluated (26 male and 3 female). Serum vitamin-D levels (25 OH D3) were determined together with standard preoperative studies. Generalized models we used to estimate the effects of age and location, as well as detection of the group of patients with levels lower than recommended.Results: 68,9% of patients had serum levels of vitamin-D lower than the normal value of 30,0 ng/mL, which was inversely associated with age, being the age of 40 the cut point from which other characteristics, like location, conditioned simultaneously the nonunion.Conclusion: the majority of patients that developed a nonunion of their fractures had vitamin-D deficiency, and this phenomenon was more evident in patients older than 40 years. Prompt identification of patients with increased risk of presenting this deficiency is important, as its treatment could reduce the incidence of fractures that evolve into a nonunion.
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Salcedo Zunino, L. A., Diaz, M. del P., Vanoli, F., Murillo, B., & Allende, C. (2016). Vitamin D levels in ununited fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(3), 163-169. https://doi.org/10.15417/576
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Clinical Research
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References
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10. Follak N, Kloting I, Merk H. Influence of diabetic metabolic state on fracture healing in spontaneously diabetic rats. Diabetes Metab Res Rev. 2005; 21:288–296.
11. Follak N, Kloting L, Wolf E, et al. Delayed remodeling in the early period of fracture healing in spontaneously diabetic BB/OK rats depending on the diabetic metabolic state. Histol Histopathol. 2004;19:473–486.
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14. Sanchez A, Oliveri B. Diagnóstico, prevención y tratamiento de la hipovitaminosis D. Rev. argent. endocrinol. metab. 2013, vol.50, n.2, pp. 140-156. ISSN 1851-3034.
15. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266-281.
16. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531-537.
17. Mithal A, Wahl DA, Bonjour J. y col. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807-20, 2009
18. Holick M, Binkley N, Bischoff-Ferrari H. y col. Evaluation, Treatment, and Prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 96: 1911-30, 2011
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20. Ocampo P, Fabre B. Déficit de vitamina D en pacientes hospitalizados. Medicina (B. Aires) 2015, vol.75, n.3, pp. 142-146
21. Weber B. G, Čech O. . Pseudarthrosis : pathophysiology, biomechanics, therapy, results. Berne, Switzerland: Hans Huber Medical Pubisher, 1976
22. Fuentes A.M., Fierro M.F. Medición de 25-hidroxivitamina D sérica: comparación de dos inmunoensayos. Revista Argentina de Endocrinología y Metabolismo 2010:47:11-17.
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24. Cranney A, Horsley T, O'Donnell S, et al Effectiveness and Safety of Vitamin D in Relation to Bone Health. Agency for Healthcare Research and Quality (US); 2007 Aug.
25. Del Sel JM. La investigación de los Errores del Metabolismo en Ortopedia y Traumatología. Revista de Ortopedia y Traumatología Latino-Americana. 1971 Mar Vol XVI, N° 1: 59-66.
26. Lancourt JE, Hochberg F. Delayed fracture healing in primary hyperparathyroidism. Clin Orthop Relat Res. 1977; 124:214–218.
27. Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions.J Orthop Trauma. 2007 Sep;21(8):557-70.
28. Avenell A, Gillespie WJ, Gillespie LD, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009;(2):CD000227.
29. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83.
30. Pourfeizi H.H., Tabriz A., Elmi A., Aslani H. Prevalence of vitamin D deficiency and secondary hyperparathyroidism in nonunion of traumatic fractures. Acta Med Iran. 2013; 51(10):705-10)
31. Van der Wielen R, Lowl M, van der Berg H. y col. Serum 25OHD concentrations among elderly people in Europe. Lancet 346:207-10, 1995
32. Gloth F, Gunberg C, Hollis B, Haddad JG, Tobin J. Vitamin D deficiency in homebound elderly persons. JAMA 274:1683-6, 1995
33. Oliveri B, Plantalech L, Bagur A. y col. High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina. Eur J Clin Nutr 58:337-42, 2004
34. Plantalech L, Fassi J, Pozzo M, y col. Hypovitaminosis D in elderly people living in an overpopulated city: Buenos Aires. En: Focus in Nutrition Research. Tony P. Starks, editor. New York; Nova Science Publishers, 2006. Págs 149-63
35. Alemzadeh R, Kichler J, Babar G, Calhoun M. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 57:183-91, 2008
36. Wortsman J, Matsuoka L, Chen TC, Lu Z, Holick M. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690-3, 2000
2. Praemer A, Furner S, Rice DP, eds. Musculoskeletal Conditions in theUnited States. Park Ridge, IL: American Academy of OrthopaedicSurgeons; 1992.
3. Sanchez A, Salerni H . Retardo de consolidación de fracturas. Actual. Osteol 2015; 11(1):47:56
4. Brinker MR. Nonunions: Evaluation and Treatment. In: Skeletal Trauma: Basic Science, Management, and Reconstruction. Browner BD, Levine AM, Jupiter JB, et al, eds. Philadelphia: W.B. Saunders; 2003:507–604.
5. de Francisco AL. Medical therapy of secondary hyperparathyroidism in chronic kidney disease: old and new drugs. Expert Opin Pharmacother. 2006;7:2215–2224.
6. Jesudason D, Need AG, Horowitz M, et al. Relationship between serum 25-hydroxyvitamin D and bone resorption markers in vitamin D insufficiency. Bone. 2002; 31:626–630.
7. Need AG. Bone resorption markers in vitamin D insufficiency. Clin Chim Acta. 2006; 368:48–52.
8. Komnenou A, Karayannopoulou M, Polizopoulou ZS, et al. Correlation of serum alkaline phosphatase activity with the healing process of long bone fractures in dogs. Vet Clin Pathol. 2005;34:35–38.
9. Kayal RA, Tsatsas D, Bauer MA, et al. Diminished bone formation during diabetic fracture healing is related to the premature resorption of cartilage associated with increased osteoclast activity. J Bone Miner Res. 2007;22:560–568.
10. Follak N, Kloting I, Merk H. Influence of diabetic metabolic state on fracture healing in spontaneously diabetic rats. Diabetes Metab Res Rev. 2005; 21:288–296.
11. Follak N, Kloting L, Wolf E, et al. Delayed remodeling in the early period of fracture healing in spontaneously diabetic BB/OK rats depending on the diabetic metabolic state. Histol Histopathol. 2004;19:473–486.
12. Hughes MS, Kazmier P, Burd TA, et al. Enhanced fracture and soft-tissue healing by means of anabolic dietary supplementation. J Bone Joint Surg Am. 2006;88:2386–2394.
13. Day SM, DeHeer DH. Reversal of the detrimental effects of chronic protein malnutrition on long bone fracture healing. J Orthop Trauma. 2001;15:47–53
14. Sanchez A, Oliveri B. Diagnóstico, prevención y tratamiento de la hipovitaminosis D. Rev. argent. endocrinol. metab. 2013, vol.50, n.2, pp. 140-156. ISSN 1851-3034.
15. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266-281.
16. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531-537.
17. Mithal A, Wahl DA, Bonjour J. y col. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807-20, 2009
18. Holick M, Binkley N, Bischoff-Ferrari H. y col. Evaluation, Treatment, and Prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 96: 1911-30, 2011
19. Sánchez A. Vitamina D. Actualización. Rev Med Rosario 76:70-87, 2010
20. Ocampo P, Fabre B. Déficit de vitamina D en pacientes hospitalizados. Medicina (B. Aires) 2015, vol.75, n.3, pp. 142-146
21. Weber B. G, Čech O. . Pseudarthrosis : pathophysiology, biomechanics, therapy, results. Berne, Switzerland: Hans Huber Medical Pubisher, 1976
22. Fuentes A.M., Fierro M.F. Medición de 25-hidroxivitamina D sérica: comparación de dos inmunoensayos. Revista Argentina de Endocrinología y Metabolismo 2010:47:11-17.
23. StataCorp (2015) Stata Statistical Software: version 14.0.College Station, TX: StataCorp LP.
24. Cranney A, Horsley T, O'Donnell S, et al Effectiveness and Safety of Vitamin D in Relation to Bone Health. Agency for Healthcare Research and Quality (US); 2007 Aug.
25. Del Sel JM. La investigación de los Errores del Metabolismo en Ortopedia y Traumatología. Revista de Ortopedia y Traumatología Latino-Americana. 1971 Mar Vol XVI, N° 1: 59-66.
26. Lancourt JE, Hochberg F. Delayed fracture healing in primary hyperparathyroidism. Clin Orthop Relat Res. 1977; 124:214–218.
27. Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions.J Orthop Trauma. 2007 Sep;21(8):557-70.
28. Avenell A, Gillespie WJ, Gillespie LD, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009;(2):CD000227.
29. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83.
30. Pourfeizi H.H., Tabriz A., Elmi A., Aslani H. Prevalence of vitamin D deficiency and secondary hyperparathyroidism in nonunion of traumatic fractures. Acta Med Iran. 2013; 51(10):705-10)
31. Van der Wielen R, Lowl M, van der Berg H. y col. Serum 25OHD concentrations among elderly people in Europe. Lancet 346:207-10, 1995
32. Gloth F, Gunberg C, Hollis B, Haddad JG, Tobin J. Vitamin D deficiency in homebound elderly persons. JAMA 274:1683-6, 1995
33. Oliveri B, Plantalech L, Bagur A. y col. High prevalence of vitamin D insufficiency in healthy elderly people living at home in Argentina. Eur J Clin Nutr 58:337-42, 2004
34. Plantalech L, Fassi J, Pozzo M, y col. Hypovitaminosis D in elderly people living in an overpopulated city: Buenos Aires. En: Focus in Nutrition Research. Tony P. Starks, editor. New York; Nova Science Publishers, 2006. Págs 149-63
35. Alemzadeh R, Kichler J, Babar G, Calhoun M. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 57:183-91, 2008
36. Wortsman J, Matsuoka L, Chen TC, Lu Z, Holick M. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690-3, 2000