Routine vitamin D testing in the trauma cohort - cause for concern?

B. Patel, Y. Ghani, C. Luney, K. Davda

Background: In the UK between 21-24% of people are Vitamin D deficient. Orthopaedic trauma patients are particularly high risk for low Vitamin D levels. Deficiency is linked to higher rates of fragility fractures and non-unions amongst other musculoskeletal manifestations. NICE guidelines advise that every adult in the UK should be taking daily Vitamin D.

Our aim was to investigate the levels of vitamin D in orthopaedic trauma admissions including foot and ankle trauma and if Vitamin D was routinely tested in these patients.

Methods: We retrospectively analysed records of orthopaedic trauma patients at our hospital between December and January 2019. Records were reviewed to ascertain whether patients received a vitamin D level at admission or while an inpatient. Severity of hypovitaminosis D was recorded along with the demographic data.

Results: A total of 123 patients were included. Just over half  (71/123) were tested on either admission or as an inpatient. 52/123 (42.3%) were not tested. Increased testing in older individuals (>70 years) was observed compared to younger cohorts (56/80 [70.0%], >70years vs 11/27 [40.7%], 40-70 years, vs 2/9 [22.2%] 18-39 years, vs 2/7 [28.6%] <18years). Out of the 71 patients tested, 27 (38%) were grossly deficient, 12 (17%) were deficient, 22 (31%) were insufficient and only 10 (14%) were normal. 17% of deficient patients were younger than 70 years of age.

Conclusions: We demonstrated a high prevalence of hypovitaminosis D in our local trauma cohort including in younger patients.  We note mediocre rates of testing in the trauma cohort <70 years of age. Given that the potential consequences of hypovitaminosis D can be costly and debilitating, we believe that routine vitamin D level testing of orthopaedic trauma could prove more cost effective and safe in the long run.