Prevalence of Vitamin D Deficiency and Secondary Hyperparathyroidism in Nonunion of Traumatic Fractures

  • Hojjat Hossein Pourfeizi Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Ali Tabriz Mail Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. AND Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Asghar Elmi Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Hossein Aslani Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Keywords:
Bone healing, Nonunion, Vitamin D deficiency

Abstract

Nonunion is common complication of fracture management. Various factors are involved in its occurring. Metabolic and endocrine factors are often overlooked. So that aim of study was to evaluate the level of vitamin D and PTH in patients with unexplained nonunion and fractures due to low energy trauma. In the case control study, 30 patients with tibial nonunion compared with 32 patients with normal bone healing. There were matched according to, surgical treatment, sex, age and body mass index. In order to measure the serum levels of laboratory parameters, vitamin D and parathyroid hormone, blood samples were taken and were sent to a reference laboratory. A high percentage of vitamin D deficiency was observed in tibial unexplained nonunion (60%) versus 30% in normal union. The level of vitamin D in patients with nonunion was significant difference compared with normal union (25.8±20.4 nmol/l versus 49.03±26.9 nmol/l, P=0.002). PTH measurement showed that was not meaningful statistical difference between two groups but prevalence of hyperparathyroidism in nonunion was higher than union (33% versus 9.3%). In other laboratory findings were not statistical difference. According to our results, vitamin D deficiency in unexplained tibial nonunion fractures are common. In areas with high prevalence of hypovitaminosis D, that could be one reason of unexplained nonunion.

References

Jones AN, Hansen KE. Recognizing the musculoskeletal manifestations of vitamin D deficiency. J Musculoskelet Med 2009;26:389–96.

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008;87(4):1080S–6S.

Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81(3):353-73.

Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7(5):439-43.

Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22(4):477-501.

McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med 1992;93(1):69-77.

Csongradi JJ, Maloney WJ: Ununited lower limb fractures. West J Med 1989;150(6):675-80.

Drosos GI, Bishay M, Karnezis IA, Alegakis AK. Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures. J Bone Joint Surg Br 2006;88(2):227-31.

Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 2007;21(8):557-70.

Eamon Laird, Mary Ward, Emeir Mc, Sorley JJ. Strain and Julie Wallace. Vitamin D and Bone Health; Potential Mechanisms. Nutrients 2010;2(7):693-724.

Lyman D. Undiagnosed Vitamin D Deficiency in the Hospitalized Patient. Am Fam Physician 2005;71(2):299-304.

Jain A K, Yadav SS. Bone health - An investment. Indian J Orthop 2009;43(3):223-4.

Batra S, Yamin M, Sabharwal S. Relationship between vitamin D insufficiency in osteoporosis and blood bone biochemistry. Indian J Orthop 2006;40(1):41-5.

Francis RM, Anderson FH, PatelS, Sahota O, Staa TP. Calcium and vitamin D in the prevention of osteoporotic fractures. QJM 2006;99(6):355–63.

LeBoff MS, Hawkes WG, Glowacki J, Yu-Yahiro J, Hurwitz S, Magaziner J. Vitamin D-deficiency and postfracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int 2008;19(9):1283–90.

Papaioannou A, Kennedy CC, Giangregorio L, Ioannidis G, Pritchard J, Hanley DA, Farrauto L, DeBeer J, Adachi JD. A randomized controlled trial of vitamin D dosing strategies after acute hip fracture: No advantage of loading doses over daily supplementation. BMC Musculoskelet Disord 2011;12:135.

Van Demark RE , Allard B, Van Demark RE Jr. Nonunion of a distal tibial stress fracture associated with vitamin D deficiency: a case report. S D Med 2010;63(3):87-91, 93.

Jackson C, Gaugris S, Sen SS, Hosking D. The effect of cholecalciferol (vitamin D3) on the risk of fall and fracture: a meta-analysis. QJM 2007;100(4):185–92.

Ömeroğlu S, Erdogan D, Ömeroğlu H. Effects of single high-dose vitamin D3 on fracture healing, An ultrastructural study in healthy guinea pigs. Arch orthop Trauma Surg 1997;116(1-2):37-40.

Steier A, Gedalia I, Schwarz A, Rodan. Effect of Vitamin= D and Fluoride on Experimental Bone Fracture Healing in Rats. J Dent Res 1967;46(4):675-80.

Rivero DP, Fox J, Skipor AK, Urban R.M, Galante JO. Calcium phosphate-coated porous titanium implants for enhanced skeletal fixation. J Biomed Mater Res 1988;22(3):191-201.

Alkalay D, Shany S, Dekel S. Serum and bone vitamin D metabolites in elective patients and patients after fracture. J Bone Joint Surg Br 1989;7l(1):85-7. 23. Lips P.Vitamin D physiology. Prog Biophy Mol Biol 2006;92(1):4-8.

Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, Soltani A, Shafaei AR, Hamidi Z, Khalili AR Fard, Hossein-Nezhad A, Booya F. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 2004,4:38.

Hovsepian S, Amini M, Aminorroaya A, Amini P, Iraj B. Prevalence of Vitamin D Deficiency among Adult Population of Isfahan City, Iran. J Health Popul Nutr 2011;29(2):149-55.

How to Cite
1.
Pourfeizi HH, Tabriz A, Elmi A, Aslani H. Prevalence of Vitamin D Deficiency and Secondary Hyperparathyroidism in Nonunion of Traumatic Fractures. Acta Med Iran. 51(10):705-710.
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