title: Vitamin D deficiency in adult fracture patients: prevalence and risk factors.
abstract: OBJECTIVE
  Although vitamin D levels are not routinely monitored in outpatient fracture patients, identification of fracture patients with a deficient vitamin D status may be clinically relevant because of the potential role of vitamin D in fracture healing. This study aimed to determine the prevalence of and risk factors for vitamin D deficiency in non-operatively treated adult fracture patients.
  
  
  METHODS
  Vitamin D levels were determined in a cross-sectional study of adult patients, who were treated non-operatively for a fracture of the upper or lower extremity in the outpatient clinic of a level 1 trauma center, during one calendar year. Potential risk factors for (severe) vitamin D deficiency were analyzed using multivariable logistic regression analysis.
  
  
  RESULTS
  A total of 208 men and 319 women with a mean age of 49.7 years (SD 19.9) were included. In this population, 71 % had a serum calcidiol <75 nmol/L, 40 % were vitamin D deficient (serum calcidiol <50 nmol/L) and 11 % were severely vitamin D deficient (serum calcidiol <25 nmol/L). Smoking and season (winter and spring) were independent risk factors for vitamin D deficiency. An increasing age, a non-Caucasian skin type, winter and smoking were identified as independent risk factors for severe vitamin D deficiency. The use of vitamin D, alcohol consumption and higher average daily sun exposure were independent protective factors against (severe) vitamin D deficiency.
  
  
  CONCLUSIONS
  Given the potential role of vitamin D in fracture healing, clinicians treating adult fracture patients should be aware of the frequent presence of vitamin D deficiency during the winter, especially in smoking and non-Caucasian patients. Research on the effect of vitamin D deficiency or supplementation on fracture healing is needed, before suggesting routine monitoring or supplementation.
authors.affiliation: Department of Surgery and Traumatology, Leiden University Medical Centre, K6-50, P.O. Box 9600, 2300, Leiden, The Netherlands. e.a.gorter@lumc.nl.
authors.forename: E A
authors.initials: EA
authors.lastname: Gorter
authors.affiliation: Department of Surgery and Traumatology, Leiden University Medical Centre, K6-50, P.O. Box 9600, 2300, Leiden, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Krijnen
authors.affiliation: Department of Surgery and Traumatology, Leiden University Medical Centre, K6-50, P.O. Box 9600, 2300, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012621:Seasons; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D014807:Vitamin D
keywords: Fracture; Fracture healing; Risk factors; Vitamin D; Vitamin D deficiency