title: Vitamin D Status in an Elective Orthopedic Surgical Population.
abstract: BACKGROUND
  Adequate vitamin D availability is required for normal bone metabolism. Hypovitaminosis D is highly prevalent in latitudes above 30 degrees. The goal of this prospective study was to determine the prevalence of hypovitaminosis D in an unselected population of patients undergoing major ankle or hindfoot arthrodesis in Burlington, Vermont (latitude 44.5° N).
  
  
  METHODS
  One hundred eighteen patients undergoing a major ankle, hindfoot, or midfoot arthrodesis between May 2012 and February 2014 were eligible for the study, of which 81 participated. All clinical data, including comorbidities, demographics, and lab values, were obtained from the comprehensive electronic medical record system that encompassed all inpatient and outpatient care. Based on the recommendations published by the Vitamin D Task Force Committee of the Endocrine Society, vitamin D levels above 30 ng/mL were considered normal. Statistical analyses were performed using a significance level of P <.05.
  
  
  RESULTS
  Of 81 patients tested, 54 (67%) had low serum vitamin D. Older patients had lower risk for hypovitaminosis D (RR = 0.953, CI = 0.908, 0.999, P = .046), whereas a Charlson Index ≥3 had increased risk (RR = 16.8, CI = 1.5, 192.3, P = .023). Of the 16 patients retested after vitamin supplementation, only 9 (56%) corrected to normal.
  
  
  CONCLUSIONS
  In an unselected population in Vermont undergoing hindfoot and ankle arthrodesis, there was a high prevalence of hypovitaminosis D, even in patients without predisposing risk factors. Consequently, routine testing or presumptive high-dose vitamin D replenishment therapy should be considered for all patients scheduled for such surgery, primarily to promote adequate skeletal calcium metabolism.
  
  
  METHODS
  Level II, prospective study.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT, USA james.michelson@uvm.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Michelson
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Charlson
mesh_terms: D000367:Age Factors; D000843:Ankle Joint / Q000601:surgery; D001174:Arthrodesis; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D033023:Foot Joints / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000175:diagnosis*
chemical_list: D014807:Vitamin D
keywords: arthritis; diabetes; outcome studies