Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Vitamin D is essential for musculoskeletal health, playing key roles in calcium absorption, bone mineralization, and skeletal remodeling. Vitamin D insufficiency and deficiency are widespread, especially in northern regions. Inadequate vitamin D is believed to negatively impact bone repair and recovery. Despite its potential importance, routine vitamin D screening remains inconsistent across orthopedic practices. Our study evaluated the frequency of vitamin D surveillance in patients with foot and ankle fractures across a major healthcare network.
Additionally, we investigated whether or not vitamin D surveillance rates have changed over time, and how they compared to similar rates for patients with hip or tibia fractures.
Methods:
Patients with calcaneus, navicular, fifth metatarsal, talus, lateral malleolus, medial malleolus, and other fractures of the lower leg (bimalleolar, trimalleolar, and pilon) were identified in the Mass General Brigham database between 2016 and 2024 using the ICD-10 codes. Patients with femoral neck and tibial shaft fractures served as controls. Electronic health records were reviewed to determine whether patients had a vitamin D level drawn in the time period spanning from one year before to 6 weeks after their fracture. Annual change in testing rates was determined using a linear regression. Chi-squared testing was used to compare testing rates across different fracture types.
Results:
Vitamin D surveillance rates are detailed in Table 1 and were less than 50% for all foot and ankle fractures. These rates ranged from 30.7% (bimalleolar, trimalleolar, and pilon) to 43.4% (5th metatarsal fractures). By comparison, surveillance rates were significantly higher in patients with hip fractures (65.1%). Over time, the rates of testing significantly increased for patients with medial malleolus, tibial, femoral neck and other fractures of the lower leg (bimalleolar, trimalleolar, and pilon). The rates of testing for navicular, talus, and 5th metatarsal fractures decreased over the 8-year interval, although these changes were not significant.
Conclusion:
Significant variability in vitamin D surveillance among patients with foot and ankle fractures was observed and overall was lower when compared to patients with hip fractures. Given the important role vitamin D plays in bone health and metabolism, our findings highlight a potential area of improvement when caring for patients with lower extremity fractures.
