title: Effectiveness of Vitamin D Therapy in Orthopaedic Trauma Patients.
abstract: OBJECTIVE
  The purpose of this study was to determine the effectiveness of our vitamin D treatment protocol in managing low serum vitamin D levels in orthopaedic trauma patients.
  
  
  METHODS
  A retrospective review was conducted of all orthopaedic trauma patients at a university level I trauma center over 20 months. Patients were included if they had an initial and repeat 25-hydroxy (OH) vitamin D serum level available. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D level with less than 20 ng/mL. Vitamin D insufficiency was defined as serum 25-hydroxy vitamin D level between 20 and 32 ng/mL. The standard regimen for all patients was over-the-counter vitamin D3 1000 IU and 1500 mg of calcium daily. Patients with vitamin D deficiency or insufficiency also received 50,000 IU of ergocalciferol (D2) weekly until their 25-hydroxyvitamin D level normalized or their fracture healed. No compliance monitoring was performed except for questioning at each clinic visit.
  
  
  RESULTS
  A total of 201 patients met the inclusion criteria. Thirty-two patients had a normal initial 25-hydroxyvitamin D level, and 84% maintained their normal level, whereas 16% became insufficient or deficient. There were 88 patients insufficient initially and 54.5% improved to normal and 8% became deficient. In the vitamin D deficiency group (81), 26% remained deficient and 74% improved to insufficient. The average increase in serum 25-OH vitamin D with treatment (in nanograms per milliliter) was statistically significant for both the insufficient and deficient groups.
  
  
  CONCLUSIONS
  Vitamin D therapy improved the majority of the patients' vitamin D-25-OH level but did not normalize most. Patients with initial deficiency had the largest improvement. This study indicates that vigilance is required to adequately treat a low serum vitamin D-25-OH level.
authors.affiliation: *Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, TX; †Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; and ‡Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Robertson
authors.forename: Tyler
authors.initials: T
authors.lastname: Jenkins
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Murtha
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Della Rocca
authors.forename: David A
authors.initials: DA
authors.lastname: Volgas
authors.forename: James P
authors.initials: JP
authors.lastname: Stannard
authors.forename: Brett D
authors.initials: BD
authors.lastname: Crist
mesh_terms: D002118:Calcium / Q000008:administration & dosage*; D002762:Cholecalciferol / Q000008:administration & dosage*; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage; D012189:Retrospective Studies; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D006887:Hydroxycholecalciferols; D002762:Cholecalciferol; D002118:Calcium