Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures

Sang-Uk Lee,Yoon-Min Lee,Sun Young Joo,Ki-Tae Na,Jong Hwa Park

doi:10.1186/s13018-020-01859-4

Abstract

BackgroundComplex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF). The purpose of this study was to investigate the relationship of vitamin D levels in surgically treated post-menopausal women with CRPS I occurrence in DRF.MethodsFrom February 2016 to March 2017, 158 surgically treated post-menopausal patients with DRF were enrolled. Exclusion criteria were (1) patients who had been taking vitamin D or osteoporosis medication at the time of injury; (2) patients with medical factors that may affect vitamin D levels; (3) patients who were reluctant to enroll in the study; and (4) patient with additional fractures, ligamentous injuries, or neuropathy. A total of 107 patients were available for final analysis. We compared the serum vitamin D levels in post-menopausal women with DRF with CRPS I (group 1) and without CRPS I (group 2). Bone mineral density (BMD) of the femur and spine, osteocalcin, alkaline phosphatase (ALP), body mass index (BMI) were also measured.ResultsThe average age at the time of surgery was 66.5 years (range, 39-86 years). The mean follow-up period was 16.3 months after surgery. Among the 107 surgically treated DRF patients, 19 (18%) met the Budapest criteria for CRPS I during the follow-up period. The mean serum vitamin D level in group 1 (15.2 ng/ml) was significantly lower than that in group 2 (20.5 ng/ml, p = 0.027). The mean values of osteocalcin, ALP, BMI, and BMD were not significantly different between the groups.ConclusionLower vitamin D levels in post-menopausal women can increase CRPS I occurrence in distal radius fractures.

Highlights

Complex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF)
Among 14 patients who were initially diagnosed with CRPS I at 4 weeks, symptoms and signs of CRPS I were persistent at 8 weeks postoperatively in patients and at weeks in 2 patients; no patients had any symptoms or signs at 16 weeks
Among 3 patients who were initially diagnosed with CRPS I at 8 weeks, symptoms and signs of CRPS I were persistent at 12 weeks postoperatively in 2 patients and at 16 weeks postoperatively in 1 patient

Summary

Introduction

Complex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF). Complex regional pain syndrome type I (CRPS I) is a chronic devastating condition involving the limbs, characterized by unexplained severe pain that is constant, extremely intense, and out of proportion to the original injury. It is accompanied by swelling, autonomic dysfunction, and joint stiffness. Prognosis of CRPS I in DRF is good if treated early and properly [2]; it becomes poor if managed late It exerts a large financial burden on the healthcare system and is a common cause of lawsuits [9]

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