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J Orthop Trauma. 2016 Feb;30(2):53-63. doi: 10.1097/BOT.0000000000000455.

What Is the Role of Vitamin D Supplementation in Acute Fracture Patients? A Systematic Review and Meta-Analysis of the Prevalence of Hypovitaminosis D and Supplementation Efficacy.

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  • 1*Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada;†Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;‡Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; and§Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.

Abstract

OBJECTIVES:

The objectives of this systematic review and meta-analyses are (1) to estimate the prevalence of hypovitaminosis D in fracture patients and (2) to summarize the available evidence on the efficacy of vitamin D supplementation in fracture patients.

DATA SOURCES:

A comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases was conducted. Conference abstracts from relevant meetings were also searched.

STUDY SELECTION:

We included studies that investigate vitamin D insufficiency or examine the effect of vitamin D supplementation on 25-hydroxy-vitamin D (25(OH)D) serum levels in fracture patients.

DATA EXTRACTION:

Two authors independently extracted data using a predesigned form.

DATA SYNTHESIS:

We performed a pooled analysis to determine the prevalence of postfracture hypovitaminosis D and mean postfracture 25(OH)D levels. We present detailed summaries of each of the studies evaluating the impact of vitamin D supplementation.

RESULTS:

The weighted pooled prevalence of hypovitaminosis D was 70.0% (95% confidence interval: 63.7%-76.0%, I = 97.7). The mean postfracture serum 25(OH)D was 19.5 ng/mL. The studies that evaluated the efficacy of vitamin D supplementation suggest that vitamin D supplementation safely increases serum 25(OH)D levels. Only 1 meeting abstract showed a trend toward reduced risk of nonunion after a single large loading dose of vitamin D.

CONCLUSIONS:

This review found a high prevalence of hypovitaminosis D in fracture patients and that vitamin D supplementation at a range of doses safely increases 25(OH)D serum levels. To date, only 1 pilot study published as a meeting abstract has demonstrated a trend toward improved fracture healing with vitamin D supplementation.

LEVEL OF EVIDENCE:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:
26429406
DOI:
10.1097/BOT.0000000000000455
[PubMed - indexed for MEDLINE]
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