Patients with vitamin D deficiency are more likely to develop complex region pain syndrome after extremity fractures: a large database propensity-matched cohort study.

PURPOSE

The purpose of this study was to investigate the association between preexisting vitamin D deficiency and the development of complex regional pain syndrome (CRPS) in patients with isolated extremity fractures.

METHODS

The TriNetX database was queried to identify patients aged 18 and older who experienced upper or lower extremity fractures. Two cohorts were created based on the presence of vitamin D deficiency. Cohorts were propensity-matched based on age, gender, race, and ethnicity, and the incidence of CRPS following fracture compared.

RESULTS

A total of 2,891,380 patients met all inclusion criteria. Among these, 1,827,308 (63.2%) sustained an upper extremity fracture, while 1,064,072 (36.8%) sustained a lower extremity fracture. Vitamin D deficiency was observed in 152,023 patients (5.3%). After 1:1 propensity score matching, both cohorts included 151,591 patients (71,557 upper extremity, 80,034 lower extremity), with no significant differences in baseline characteristics. The incidence of CRPS was 0.24% for upper and 0.27% for lower extremity fractures. Patients with vitamin D deficiency had a higher risk of CRPS following both upper (OR 1.60, 95% CI 1.29-2.00; p < 0.001) and lower (OR 1.78, 95% CI 1.46-2.16; p < 0.001) extremity fractures. No association was found between preexisting vitamin D deficiency and CRPS after surgical intervention for either upper (OR 1.14, 95% CI 0.56-2.34; p = 0.715) or lower extremity fractures (OR 1.46, 95% CI 0.95-2.24; p > 0.084).

CONCLUSION

Vitamin D deficiency is independently associated with an increased risk of CRPS among patients sustaining upper and lower extremity fractures.

LEVEL OF EVIDENCE

Retrospective cohort study (prognosis); level of evidence, 3.