Ryan Fitzgerald, DPM PRESENT RI Associate Editor Hess Orthopedics & Sports Medicine Harrisonburg, Virginia

Vitamin D Deficiency

There is increasing evidence in the literature to suggest that Vitamin D, a collection of steroid hormones necessary in promoting appropriate bone health, is vital in a number of metabolic processes within the human body. Vitamin D plays a major role in the regulation of bone mineralization through calcium and phosphate metabolism, and a deficiency of these hormones has been linked to numerous systemic disorders including heart disease, cancer, diabetes, and poor bone health.

Among these potential negative systemic disorders, poor bone health should be of particular concern to those clinicians involved in the management of osseous disorders.  Several journals, including the Annals of Internal Medicine, have recently published articles regarding Vitamin D, and its role in health.  While there is certainly a link between low Vitamin D levels and poor overall health, what is yet to be sufficiently determined is the degree of the link, as well as the efficacy of Vitamin D supplementation to address potential insufficiency. 

There is a significant amount of anecdotal information available regarding Vitamin D deficiency, and its relationship to the development of stress fractures, non-unions, and other negative osseous outcomes — I can certainly provide numerous examples from my own practice — however, there have been relatively few prospective, randomized studies, as yet, to determine the relationship between Vitamin D deficiency and the development of these types of osseous pathology.

While obtaining higher level evidence is certainly important, I would argue that in the interval, there is relatively little harm in assessing your patient’s Vitamin D levels and treating appropriately with supplementation when the value is found to be below normal.  I would challenge each of you to consider Vitamin D deficiency as a contributing factor in the face of patients who present in your resident clinics with stress fractures and non-unions.  I am certain that, if you start looking, you will find, as I did, that there is a significant number of patients who will present with a deficiency. We must consider that this is a metabolic deficiency — one we can correct.  We are aware of the value of determining the nutritional status in wound healing patients to assess their capacity to heal; I posit that the evaluation for and management of Vitamin D deficiency is no different.

It has become my standard protocol to obtain vitamin D levels on all of my preoperative patients who will be undergoing some type of arthrodesis procedure.  I also screen any patient who presents with a stress fracture, especially those without other underlying risk factors.  I have been surprised how many lab values return well below normal.  I challenge you to try it for yourself!

We at PRESENT love hearing from you. I would encourage you to share your experience, pearls, and wisdom on this topic, or on any other that you would like to share with our online community via eTak. 
Your continued participation is what makes this Web portal great!

Get a steady stream of all the NEW PRESENT Podiatry eLearning by becoming our Facebook Fan. Effective eLearning and a Colleague Network await you.

Grand Sponsor
Diamond Sponsor
Major Sponsors