Prevalence of vitamin D deficiency in adult limb lengthening and deformity correction patients

Abstract

Introduction: Limb lengthening and deformity correction surgery (LLDC) requires adequate bone metabolism for distraction osteogenesis. Low Vitamin D is a common nutritional deficit that places bone health at risk and has been associated with fracture. It is currently unknown what the Vitamin D levels are among patients undergoing elective osteotomy. The goal of this research is to determine the prevalence of Vitamin D deficiency in adult patients undergoing lower extremity osteotomies for LLDC. Materials and Methods: A retrospective review was performed for adult patients (≥18 years old) who underwent an osteotomy surgery at a single institution between 2014 and 2018. The primary outcome measure was perioperative 25(OH)D serum level. Of 139 subjects identified as undergoing a lower extremity osteotomy surgery, 96 (69%) underwent perioperative Vitamin D testing. Deficiency and insufficiency were defined as a 25(OH)D value of <20 ng/mL and between 20 and 30 ng/mL, respectively. Results: Patients undergoing external fixator placement for length and/or deformity correction were most likely to have this laboratory assessed (88%) versus acute correction patients (65%) and intramedullary lengthening patients (62%), (P = 0.033). The mean Vitamin D level was 29.5 ± 17.8 ng/mL (range: 5.7–95.9 ng/mL). A total of 63% of patients had low perioperative Vitamin D: 33.3% deficient, 30.2% insufficient. Conclusion: The majority of adult LLDC patients have deficient or insufficient Vitamin D levels perioperatively. Vitamin D “prehabilitation” whereby testing and repleting before limb lengthening surgery should be highly considered as standard practice.