by Craig Weatherby
Disturbing new findings show that vitamin D deficiency is very common among people undergoing routine orthopedic procedures.
And disturbingly, the study found that this nutritional shortfall poses serious risks during and after surgery.
Researchers at New York City’s Hospital for Special Surgery (HSS) report that almost half of all patients undergoing orthopedic surgery had a vitamin D deficiency.
Vitamin D is essential for bone healing, muscle function, and proper recovery from orthopedic surgery… and the study’s authors made it clear that this nutritional lack must be corrected beforehand.
“In the perfect world, test levels, fix and then operate,” said Joseph Lane, M.D., professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at HSS, who led the study (HHS 2010).
As he went on to say, “If you put people on 2,000-4,000 milligrams of vitamin D… you can usually get them corrected in four to six weeks… If you are really aggressive [with giving them high doses] right before surgery, you can correct deficient levels [more] quickly...” (HHS 2010).
According to Dr. Lane, bone “remodeling” (tissue formation) is a part of the healing process that occurs about two to four weeks after surgery, making this a critical stage when your body needs vitamin D. (HHS 2010)
But vitamin D also matters in the midst of the common orthopedic “arthroplasty” procedures, such as hip and knee replacements.
According to Dr. Lane, “With arthroplasty, there is a certain number of patients that when you put in the prosthesis, it breaks the bone adjacent to the prosthesis, which can really debilitate patients” (HHS 2010).
He said that this could be prevented or minimized by raising vitamin D levels.
In addition, vitamin D matters for procedures where the goal is to grow bone into the prosthesis without using cement.
As Dr. Lane noted, “In those people, it would be an advantage to have adequate vitamin D, because it matures the bone as it grows in… it is really healing into the prosthesis” (HHS 2010).
The HHS team conducted a retrospective study in 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008.
Vitamin D blood levels had been measured in all patients before their surgery, and the team’s analysis found that 43 percent had insufficient vitamin D while 40 percent had deficient levels.
Vitamin D insufficiency was defined as having blood levels from 20 to 32 ng/mL, and vitamin D deficiency was defined as having blood levels below 20 ng/mL.
Lack of vitamin D was more prevalent in patients aged 50 or younger, among men, and in people with darker skin, which blocks the UV sunrays that stimulate creation of vitamin D in the skin.
The highest levels of deficiency were seen in patients in the trauma service, where 66 percent of patients had insufficient levels and 52 percent had deficient levels.
Of the patients undergoing foot and ankle surgery, 34 percent had inadequate levels; and of patients undergoing hand surgery, 40 percent had insufficient levels.
In the Sports Medicine Service, 52.3 percent had insufficient levels and of these, one-third had deficient levels.
Dr. Lane offered some advice to patients: “We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier faster, better, result” (HHS 2010).
And he directed a sharper reminder to surgeons: “What we are saying [to doctors] is ‘wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it” (HHS 2010).
The causes (and cures) of vitamin D deficiency
Virtually all vitamin D researchers agree that the U.S. recommended daily allowances (RDA) are much too low.
The current RDAs range from 200 (birth through age 50), 400 IU (age 51-70), and 600 IU (age 71-plus).
Most experts propose raising the RDAs to 1000 IU, 2000 IU, or even more.
The only good food sources are fatty fish, with certain species having the most (200 IU to 700 IU per 3.5 oz serving).
These include albacore tuna, sardines, mackerel, and wild salmon (farmed salmon has far less), with sockeye salmon leading the pack at about 700 IU per 3.5 oz serving.
Supplements provide an easy, convenient, measured way to achieve ample vitamin D blood levels.
Of the two supplemental forms—vitamin D2 (from yeast) and vitamin D3 (from lanolin)—most evidence indicates that vitamin D3 is more efficient and effective, perhaps because it is the active form naturally found in human bodies.
While people can absorb vitamin D from sunlight or tanning lamps, these are less reliable or—if you get too much exposure—riskier ways to raise blood levels, compared with supplements.
And practically speaking, many people work indoors and use summertime sunscreens that prevent burning but also block the UV sunrays needed to stimulate vitamin D production in the skin.
Bogunovic L et al. Hypovitaminosis D in Patients Scheduled to Undergo Orthopaedic Surgery: A Single-Center Analysis.J Bone Joint Surg Am, Oct 2010; 92: 2300 - 2304. doi:10.2106/JBJS.I.01231
Hospital for Special Surgery (HSS). Vitamin D Deficiency Rampant in Patients Undergoing Orthopedic Surgery, Damaging Patient Recovery. October 6, 2010. Accessed at http://www.hss.edu/newsroom_vitamin-d-deficiency-rampant-in-patients.asp