Hoxha Miledi, Heinz Tizian, Rudert Maximilian, List Kilian, Achenbach Leonard, Maier Gerrit, Weißenberger Manuel, Horas Konstantin
Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany.
Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany.
Nutrients. 2025 Aug 14;17(16):2635. doi: 10.3390/nu17162635.
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 ( = 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; < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, = 0.044) and the highest levels in summer ( = 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, = 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.
维生素D缺乏是一个全球性的重大健康问题。据估计，全球约有10亿人的维生素D水平不足。这一现象与多种骨科疾病的负面影响直接相关。此外，目前有充分的证据表明，计划进行全关节置换术（TJA）的患者围手术期维生素D水平会影响手术结果和愈合过程。迄今为止，仅有少数研究关注计划进行上肢（肩部和肘部）全关节置换术患者的维生素D水平。因此，本研究的目的是确定该患者群体中维生素D缺乏的患病率。
在一项单中心队列研究中，对所有接受全肩关节或全肘关节置换术的患者术前测定血清25-羟基维生素D（25OHD）水平。从病历中记录人口统计学和围手术期数据以及合并症，以评估维生素D缺乏的潜在风险因素。采用多因素回归分析确定维生素D不足和缺乏的风险因素。
在12个月的时间里，共纳入了108例上肢全关节置换术患者。值得注意的是，28.7%（31/108）的患者报告定期服用维生素D补充剂。其中62.3%（19/31）的患者维生素D水平充足，而38.7%（12/31）的患者维生素D水平不足，另有6%（2/31）的患者维生素D水平缺乏（<20 ng/mL）。显著的是，87%未报告定期服用维生素D的患者（n = 77）血清维生素D水平较低。特别是，63.6%（49/77）的患者维生素D缺乏，23.4%（18/77）的患者维生素D不足，只有13%的患者血清维生素D水平高于或等于30 ng/mL，被认为是充足的（维生素D替代组的平均血清25(OH)D = 36.4 ng/mL，未替代组为18.4 ng/mL；P < 0.0001）。此外，维生素D水平随季节变化，春季记录到的水平最低（OR = 4.32，P = 0.044），夏季最高（与春季相比P = 0.005）。
接受全肩关节或全肘关节置换术的患者维生素D缺乏风险增加（服用维生素D补充剂的患者缺乏的几率降低94%；OR = 0.06，P = 0.001）。关节置换术时的季节情况似乎是维生素D水平低的关键风险因素。因此，建议将术前血清维生素D水平测量作为常规术前护理的一个组成部分。
