title: Patients presenting with fractures are likely to be vitamin D deficient: are we getting enough sun?
abstract: BACKGROUND
  25-Hydroxyvitamin D serves a crucial role in bone metabolism through its role on osteoclast and osteoblastic function. To assess the implication of vitamin D and its relationship to bone fracture and fracture force, we have examined vitamin D levels in patients requiring inpatient fracture management.
  
  
  METHODS
  We performed serological testing of vitamin D levels, calcium, parathyroid hormone and liver function tests on patients admitted to our rural institution in southeastern Australia for inpatient fracture management. All participants completed a questionnaire designed to screen for potential contributing factors to bony fragility. Demographic data were also obtained including age, gender and body mass index. Fracture location and the type of inpatient management as well as the force of injury were included in our analysis.
  
  
  RESULTS
  We recruited 100 patients to the study, with a median age of 72 (range 22-98) of whom 66 were women. Most had low-energy fractures (79%), treated by internal fixation (73%) or arthroplasty (9%) with 18 treated non-operatively. The majority of the patients were at best vitamin D insufficient, <75 nmol/L (77%), and 38% were vitamin D deficient (<50 nmol/L). Only 14 patients had a formal diagnosis of osteoporosis at presentation, with 63 patients claiming daily sun exposure in line with recommendations for vitamin D sufficiency.
  
  
  CONCLUSIONS
  Our data suggest that the prevalence of vitamin D insufficiency and deficiency is common in patients presenting with fractures in southeastern Australia and is not confined to elderly patients. All patients with fractures should be assessed for vitamin D levels and treated in accordance with vitamin D deficiency guidelines.
authors.affiliation: Warrnambool Campus, Deakin University Medical School, Geelong, Victoria, Australia.
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Mow
authors.affiliation: Warrnambool Campus, Deakin University Medical School, Geelong, Victoria, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Stokes
authors.affiliation: Warrnambool Campus, Deakin University Medical School, Geelong, Victoria, Australia.
authors.forename: Alasdair G
authors.initials: AG
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000097:blood* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010010:Osteoclasts / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D013472:Sunlight; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium
keywords: deficiency; fracture force; internal fixation