Monisha Kumar, MD
Physician
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Taylor Kann, MD
Physician
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Jessica Krizo, PhD
Research Faculty
Cleveland Clinic Akron General
Akron, Ohio, United States
Disclosure information not submitted.
Caroline Mangira, MPH, RN
Biostatistician
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Stacy Cowan, MPH
Graduate Student
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Ali Mallat, MD, MS, FACS
Executive Medical Director, Acute Care Surgery
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Farid Muakkassa, MD
Medical Director, Trauma
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Title: Prevalence of Vitamin D Deficiency and Associated Fracture Risk in Geriatric Trauma Patients
Introduction: The prevalence of vitamin D deficiency among older adults in the United States ranges from 20-100%. Low Vitamin D (VitD) is associated with higher risk of osteoporosis, falls, low immunity and poor healing. This study sought to identify the prevalence of Vitamin D deficiency (VDD) in geriatric trauma patients presenting with falls and risk of traumatic fractures.
Methods: This was a retrospective chart review of patients 65 years of age and older presenting to a Level1 Trauma Center for a fall during a one year period and had a 25-hydroxy VitD level measured. Patients with seizures, end-stage renal disease, and chronic glucocorticoid use were excluded. VitD levels (ng/ml) in patients was categorized as sufficient VDS( >30), insufficient VDI(20-30), or deficient VDD(< 20). Data were analyzed by Chi-square, Fisher’s exact test or one way ANOVA, as appropriate, with level of significance at p< 0.05. Analyses were performed using SAS® Software (version 9.4; Cary, NC).
Results: The mean age of participants was 81 years, 66% were female and 95% were Caucasian. Of 438 patients, 81 (18.49%) were VDD, 115 (26.26%) were VDI and 242 (55.25%) were VDS. Among the VDI and VDD patients, 28% and 9% were already on VitD supplements, respectively. The majority (82.88%) of falls were mechanical in nature. 90.12% of VDD patients sustained a fracture as compared to 89.57% of VDI and 86.36% of VDS patients. VDS patients were 32% less likely to have developed fractures as compared VDD, although this was not statistically significant, AOR 0.68, 95% CI 0.3 – 1.56. Among the patients with VDD, Lower extremity (LE) fractures (39.51%) were more prevalent than spine (18.52%), chest (19.75%), pelvis (6.17%), upper extremity (4.81%) fractures. Mean length of stay in patients with VDD (4.11 days) was longer as compared to VDI (4.23) and VDS (3.33) patients.
Conclusions: VitD deficiency in geriatric trauma patients correlates to an increased risk for traumatic fractures. There is an increased likelihood of sustaining LE/femur fracture as compared to other fractures. Shorter length of stay for patients with VDS as compared to VDD patients highlights the role of adequate vitD levels in the recovery/healing process. Screening geriatric patients for VDD, monitoring, and optimizing VitD levels may decrease fall-related fracture risk.