Hypovitaminosis D in adult patients scheduled for orthopaedic surgery: a cross-sectional and observational study

INTRODUCTION

Vitamin D deficiency, or hypovitaminosis D, is an increasingly recognized public health issue worldwide, affecting over one billion people.¹ Vitamin D is essential for calcium balance, bone health, and muscle function. Approximately 90% of the body’s vitamin D is synthesized in the skin upon exposure to sunlight, where ultraviolet B (UVB) rays convert 7-dehydrocholesterol to pre-vitamin D3, later transformed into cholecalciferol (vitamin D3).² Dietary sources provide vitamin D2 (ergocalciferol). Both forms are hydroxylated in the liver to form 25-hydroxyvitamin D (25(OH)D), and subsequently in the kidney to produce the biologically active hormone 1,25-dihydroxyvitamin D (calcitriol).³

The recommended daily intake for adults is 400–800 IU.⁴ Serum 25(OH)D levels <20 ng/ml are considered deficient, 20–30 ng/ml insufficient, and >30 ng/ml optimal.⁵ Deficiency is prevalent among hospitalized patients, nursing home residents, obese individuals, and older adults.⁶ In India, studies have reported widespread deficiency, with Marwaha et al noting a prevalence of 53.4% in Jammu and Kashmir.⁷

In the orthopaedic context, adequate vitamin D is vital for fracture healing, implant fixation, and reducing complications such as infections or non-union.8 Several international studies have reported high rates of deficiency in orthopaedic surgical populations, but Indian data remain scarce.^9,10

The present study aims to assess the prevalence of hypovitaminosis D in adult orthopaedic surgery patients and identify associated demographic factors.

METHODS

Study design and setting

This cross-sectional observational study was conducted at the Department of Orthopaedics, Government Medical College, Jammu—a tertiary care centre in North India—from September 2023 to February 2024.

Ethical approval

Institutional ethics committee clearance was obtained prior to study initiation (approval no. GMCJ/IEC/2023/241). Written informed consent was obtained from all participants.

Inclusion criteria

Inclusion criteria included participants aged >20 years, scheduled for elective orthopaedic surgery and medically fit for surgery.

Exclusion criteria

Exclusion criteria included individual aged ≤20 years, severe medical comorbidities (e.g., chronic liver disease, advanced CKD) and incomplete laboratory records.

Data collection

Demographic data (age, sex), body mass index (BMI), and serum 25(OH)D levels were recorded. BMI categories included- normal: 18.5–24.9 kg/m², overweight: 25.0–29.9 kg/m² and obese: ≥30 kg/m².

Laboratory analysis

Serum 25(OH)D was measured preoperatively using liquid chromatography–tandem mass spectrometry in the hospital laboratory.

Definitions involved deficiency: <20 ng/ml, insufficiency: 20–30 ng/ml and optimal: >30 ng/ml.⁵

Statistical analysis

Data were analysed using statistical package for the social sciences (SPSS) v26.0. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as frequencies and percentages. A p<0.05 was considered statistically significant.

RESULTS

Demographics

The mean age was 56.17±15.23 years (range: 42–74). Of the 50 patients, 29 (58%) were males and 21 (42%) females. The highest prevalence of patients was in the 61–70-year age group (Table 1).

BMI distribution

Mean BMI was 25.61±4.21 kg/m²; 38% were overweight, and 22% obese (Table 2). Nearly 60% were overweight or obese, groups that showed higher deficiency prevalence.

Vitamin D status

Overall, 30% had deficiency, 40% insufficiency, and 30% optimal levels (Table 3). 70% of patients had suboptimal vitamin D levels.

DISCUSSION

This study was found a 70% prevalence of suboptimal vitamin D levels in orthopaedic surgical patients, aligning with Bogunovic et al, who reported 73% deficiency/ insufficiency in the US. The 30% outright deficiency rate in our cohort is slightly higher than the 26% reported by Glowacki et al in-arthroplasty patients.^9,10

Age and sex trends

Deficiency was more common in the 61–70-year age group, consistent with Guardia et al, who noted higher prevalence in older adults due to reduced skin synthesis and mobility limitations.¹¹ Males showed slightly higher deficiency rates than females, a finding that contrasts with some studies, suggesting possible regional or lifestyle influences.¹²

BMI and vitamin D status

The data support prior reports that overweight and obese individuals have lower bioavailable vitamin D due to sequestration in adipose tissue.¹³

Clinical implications

Deficiency may impair bone healing, increase infection risk, and delay rehabilitation.¹⁴ Given these risks, routine screening and supplementation should be considered, especially for high-risk subgroups.

Limitations

This study is limited by its small sample size, single-centre design, and lack of seasonal variation assessment. Future multicentric studies with larger cohorts are recommended.

CONCLUSION

Hypovitaminosis D is highly prevalent among adult orthopaedic surgery patients in North India, especially in overweight males and older adults. Preoperative screening and correction should be integrated into surgical protocols to optimize outcomes.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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