title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Two authors independently extracted data using a predesigned form.
  
  
  RESULTS
  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.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *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.
authors.forename: Sheila
authors.initials: S
authors.lastname: Sprague
authors.forename: Brad
authors.initials: B
authors.lastname: Petrisor
authors.forename: Taryn
authors.initials: T
authors.lastname: Scott
authors.forename: Tahira
authors.initials: T
authors.lastname: Devji
authors.forename: Mark
authors.initials: M
authors.lastname: Phillips
authors.forename: Hayley
authors.initials: H
authors.lastname: Spurr
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D