Correct vitamin D deficiency before surgery, orthopedist recommends

Talker

Hall of Fame
Chances are your surgeon or doctor missed this as many are not up to date on the latest research. However, keeping your vitamin D levels up at all times is optimal for best outcomes. Along with this calcium is needed with magnesium, boron, viatmin K(k2 in particular).
In sports you will probably have some bone problems, bruises, breaks and fractures to name a few. The article addresses that if bone surgery is planned then vitamin D levels should be checked and brought up to optimum levels.

This is good but you can go one step further and make sure the levels are already optimal as it takes awhile to get the vitamin D levels up if they are low. This would help if surgery has to be done immediately and for broken bones, the body would have what is needed immediately and not weeks.



The October 6, 2010 issue of The Journal of Bone and Joint Surgery reports that nearly half of orthopedic surgery patients are deficient in vitamin D, a condition that impairs bone healing, muscle function and surgery recovery.

Professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at New York's Hospital for Special Surgery Joseph Lane, MD and colleagues reviewed the charts of 723 men and women scheduled for orthopedic surgery from January, 2007 to March, 2008. Forty-three percent of the patients had insufficient preoperative vitamin D levels, defined as 20 to 32 nanograms per milliliter, and 40 percent had deficient levels of less than 20 nanograms per milliliter. Younger individuals, men, and those with dark skin were likeliest to be low in vitamin D.

Dr Lane explained that healing of bony tissue takes place two to four weeks following bone surgery, and sufficient vitamin D is needed for this process. "In the perfect world, test levels, fix and then operate," Dr Lane stated. "If you put people on 2,000-4,000 [milligrams] of vitamin D based on what their deficient value was, you can usually get them corrected in four to six weeks, which is when you are really going to need the vitamin D. If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it."

Sixty percent of trauma service patients had insufficient levels and 52 percent were deficient. A high percentage of vitamin D insufficiency was also observed in Sports Medicine and Arthroplasty (hip and knee replacement) services. "We frequently see stress fractures in the Sports Medicine Service and if you want to heal, you have to fix the calcium and vitamin D," Dr. Lane noted. "With arthroplasty, there is a certain number of patients that when you put in the prosthesis, it breaks the bone adjacent to the prostheses, which can really debilitate patients.

"This study should serve as a wake-up call to orthopedists that vitamin D deficiency is widespread, not necessarily tied to age, sex or background and screening for it should be part of routine presurgical care for adults," Dr Lane stated. "Meanwhile, patients who are planning to undergo any orthopedic procedure can request a screening (specifically, a blood test called the 25 hydroxyvitamin D test) or ask to be placed on a medically supervised vitamin D supplement regimen prior to surgery."

"The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable," he concluded. "We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier, faster, better, result. What we are saying is 'wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.
 

larry10s

Hall of Fame
good info. i could see the usefulness for bone procedures. the article mentions muscle procedures too.
The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable
maybe someone can explain that.?
 

ollinger

G.O.A.T.
I think most doctors in fact are up to date on it. Vitamin D has been the supplement of particular attention the last few years and a huge percentage of the people I consult on in the hospital are on it per recommendation. D levels are fairly routine these days.
 

ollinger

G.O.A.T.
(note -- a large percentage of the low levels are in people who don't go for routine medical evaluation but rather present at a time of trauma.)
 

Talker

Hall of Fame
(note -- a large percentage of the low levels are in people who don't go for routine medical evaluation but rather present at a time of trauma.)

This could be true. Some people don't give their doctor a chance to give them information, it probably accounts for a good portion. Those that have the advice may not use it, so there would be some of the percentage there.
Both sides of the doctor/patient equation have to do their part.
 

LuckyR

Legend
Well of course a high percentage of folks who have fractures have low Vitamin D, that's why they have the fracture, duh.

Guess what? A high percentage of patients having lung resections for cancer, either smoke or worked in coal mines.

A moderately sized study proving nothing, except that a bunch of New York Orthopedists at a fancy Specialty facility are kind of missing the boat in the office, while they shine like stars in the OR. Who would have predicted that?
 

Talker

Hall of Fame
Well of course a high percentage of folks who have fractures have low Vitamin D, that's why they have the fracture, duh.

We don't have data on how many could have been prevented from adequate levels of vitamin D. You missed the point of the article here, read it again.

Guess what? A high percentage of patients having lung resections for cancer, either smoke or worked in coal mines.

Probably true.

A moderately sized study proving nothing, except that a bunch of New York Orthopedists at a fancy Specialty facility are kind of missing the boat in the office, while they shine like stars in the OR. Who would have predicted that?

The study was made for a reason, the reason being it is built on what is already known, this isn't new and anyone who is familiar with this area already has come to these conclusions long ago. The study just adds validation.

What else do you want to know?
 

LuckyR

Legend
What do I want to know? Useful information like:

What percent of age matched controls (who don't have a fracture) of the study population have Vit D deficiency?

Of the study population that happened to have a surgeon who diagnosed Vit D deficiency and treated it, how much did the level improve?

And of those, did they do better after the surgery was done compared to those who didn't have their Vit D repleted?
 

Talker

Hall of Fame
What do I want to know? Useful information like:

What percent of age matched controls (who don't have a fracture) of the study population have Vit D deficiency?

Since most people don't have fractures( I would guess less than 1 percent of population) then you can just take the whole population.
Estimates vary, probably more than 50% have less than 32 ng/ml. Depends on what the season is, it's sun related. Depends on weight and skin color too.
There's data on all of it somewhere, I've seen it but don't have it handy right now. Trust me. :)

Of the study population that happened to have a surgeon who diagnosed Vit D deficiency and treated it, how much did the level improve?

If your talking about vitamin D level they try for at least 32 ng/ml as a minimum.
Many doctors put patients on 50,000 IU a week for a few months. That's 7 grand a day average plus what you get from other sources. Then have them tested again.

I made a calculation that every 5,000 IU/day you take, in 2-3 months your level will rise about 40 ng/ml, it's almost linear but not quite, variations for each persons unique system can't be calculated too accurately. You have to test to be sure.

And of those, did they do better after the surgery was done compared to those who didn't have their Vit D repleted?

The article says they have done better, it's the doctors call in this case to make the determination but there are other studies showing faster bone healing, even less loss of cartilage has been documented using some kind of scanning for cartilage thickness, but that's another thread.


Good that you don't trust an article, check it out for yourself, if you find anything new bring it back, it could help someone.
 

Soul

Semi-Pro
Saw on Dr Eades web sight today a study about D3 and magnesium. The two interact well to enhance the immune system.

" Vitamin D and Magnesium Quotes: "There are compelling reasons to believe that examining interactions between.."

http://twitter.com/DrEades

It's worked well for me. I've been taking the two supplements for around 5 years and have had only one short cold during that time.
I take 8000ius of D3 a day in order to keep a testing level between 60 to 70ng/ml. I also take 400mgs of magnesium.
 

Talker

Hall of Fame
It's worked well for me. I've been taking the two supplements for around 5 years and have had only one short cold during that time.
I take 8000ius of D3 a day in order to keep a testing level between 60 to 70ng/ml. I also take 400mgs of magnesium.

That's an outstanding reading! That's the kind of reading I shoot for myself.

Magnesium is often overlooked but is definitely needed, 400mg is a good amount.

I have been taking a 50,000 IU of D3 every 10 days, and about 2500 IU daily.
Comes to 7500 IU a day.
Then 700 mgs magnesium from vitamins alone.
 

LuckyR

Legend
What percent of age matched controls (who don't have a fracture) of the study population have Vit D deficiency?

Since most people don't have fractures( I would guess less than 1 percent of population) then you can just take the whole population.
Estimates vary, probably more than 50% have less than 32 ng/ml. Depends on what the season is, it's sun related. Depends on weight and skin color too.
There's data on all of it somewhere, I've seen it but don't have it handy right now. Trust me. :)

Of the study population that happened to have a surgeon who diagnosed Vit D deficiency and treated it, how much did the level improve?

If your talking about vitamin D level they try for at least 32 ng/ml as a minimum.
Many doctors put patients on 50,000 IU a week for a few months. That's 7 grand a day average plus what you get from other sources. Then have them tested again.

I made a calculation that every 5,000 IU/day you take, in 2-3 months your level will rise about 40 ng/ml, it's almost linear but not quite, variations for each persons unique system can't be calculated too accurately. You have to test to be sure.

And of those, did they do better after the surgery was done compared to those who didn't have their Vit D repleted?

The article says they have done better, it's the doctors call in this case to make the determination but there are other studies showing faster bone healing, even less loss of cartilage has been documented using some kind of scanning for cartilage thickness, but that's another thread.


Good that you don't trust an article, check it out for yourself, if you find anything new bring it back, it could help someone.


Not to beat a dead horse but:

Noone cares about the population as a whole, since the study population (the one's with the fractures) are not respresented by the whole population. Folks with hip fractures, for example are significantly older, less active and have much lower sun exposure than average.

I agree with you that you can't extrapolate on the effect of Vit D supplementation and that it has to be measured. That's what I'm after: the percentage measurement.

I also agree that the article mentioned that the surgeons "thought" the patients did better and that in vitro studies seem to show benefit. But that does not equal true clinical benefit of treatment (as I believe you probably already know).
 

Talker

Hall of Fame
Not to beat a dead horse but:

Noone cares about the population as a whole, since the study population (the one's with the fractures) are not respresented by the whole population. Folks with hip fractures, for example are significantly older, less active and have much lower sun exposure than average.

This is generally true, there's studies that show supplementation in this group of older individuals have lower incidence of hip fractures.

I agree with you that you can't extrapolate on the effect of Vit D supplementation and that it has to be measured. That's what I'm after: the percentage measurement.

I don't have any other information than what's in the article, it would be nice to have the actual numbers behind the article to analyze it further.

I also agree that the article mentioned that the surgeons "thought" the patients did better and that in vitro studies seem to show benefit. But that does not equal true clinical benefit of treatment (as I believe you probably already know).

Some of these studies are somewhat limited in that they don't do a full investigation. I have the advantage of following some of the other studies that are related. Putting all of these studies together, the pattern fits very nicely with hardly any studies finding anything to oppose the results of the studies.
And yes it's true that this one study does little on it's own, what is important is that it agrees with so many others. The doctor(s) here have an easy way to publish something that is generally known without much risk of being called on it. I guess you can say they are tooting their horn.

There's quit a few areas in the study that lead to other questions, these doctors are probably up to date with some of the latest research but just take what they know and put it into a general article, leaving it up to the reader to fill on the holes.
There's plenty to fill in as there are some who work on it daily with a strong amount education in this area.

The main point of the article was to make sure the vitamin D levels were at least 32ng/ml before surgery. This is the minimum, they left out the point that it would be good to always have at least this level in case of emergencies and never brought up bone health in general, it was a targeted article to other doctors in the field, as it looks to me.
 

Shroud

Talk Tennis Guru
good info. i could see the usefulness for bone procedures. the article mentions muscle procedures too.
The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable
maybe someone can explain that.?
This seems intentional. Overreacting about sun exposure leads to vitamin d deficiency which keeps us sick. More money flowing in.
 

mcs1970

Hall of Fame
This seems intentional. Overreacting about sun exposure leads to vitamin d deficiency which keeps us sick. More money flowing in.

A lot of people have genetic issues with Vitamin D production. I play in the hot Texas sun for 6-8 hours a week apart from other outdoor activities , but am still woefullly deficient unless I supplement.
 
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