High Prevalence of Vitamin D Deficiency in Patients Undergoing Total Shoulder or Elbow Arthroplasty

Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective.

In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency.

Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring).

Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care.