SLR - September 2023 - Mohapatra
Title: Prevalence of Vitamin D Deficiency in Patients with Charcot Arthropathy: A Single-Center AnalysisReference: Kay RD, Forslund J, Arthur D', Taylor AJ, Aminian A. Prevalence of Vitamin D Deficiency in Patients With Charcot Arthropathy: A Single-Center Analysis. J Am Acad Orthop Surg Glob Res Rev. 2022;6(10):e22.00162. Published 2022 Oct 21. doi:10.5435/JAAOSGlobal-D-22-00162
Level of Evidence: 2
Reviewed By: Diksha Mohapatra, DPM
Residency Program: Our Lady of Lourdes Memorial Hospital, Binghamton, NY
Podiatric Relevance: In patients with Charcot neuroarthropathy, bone density analysis has indicated evidence of osteopenia and an elevated chance of neuropathic fractures. Vitamin D deficiency may be a factor in worsening Charcot, fractures, and postoperative failure of fixation. Pre operative optimization of Vitamin D levels could improve the prognosis in patients with Charcot. The study was completed to discover the prevalence of vitamin D deficiency with Charcot, as no studies were done on the subject before. The authors hypothesized that there is high prevalence of vitamin D deficiency and insufficiency with Charcot.
Methods: The inclusion criteria was all patients with active or chronic Charcot from January 2017 to June 2021. Active Charcot was defined as patients with acute edema/warmth of foot/ankle with fractures at initial presentation. Chronic Charcot was defined as patients with no edema/warmth of foot/ankle, mature fractures, and stable deformity. Patients with previously known vitamin D deficiency or insufficiency and with recent vitamin D supplementation were excluded. Serum 25-hydroxyvitamin D was drawn from patients with acute and chronic Charcot. When serum Vitamin D was collected from patients with active Charcot, they were treated with total contact casts. When vitamin D was collected from patients with chronic Charcot, they were treated with Charcot Restraint Orthotic Walker boots, controlled ankle motion boots, or shoes. If patients were Vitamin D deficient/insufficient, they began taking a supplement of 1000 IU of vitamin D3 and were referred to a primary care physician.
Results: Of the 57 patients selected for the study, 31 (54.4%) were male, and 26 (45.6%) were female. The mean age was 53.3 ± 7.92 (range 39 to 78) years. Of the 57, all patients had diabetes mellitus, 16 (28.1%) patients had an active Charcot process, and 41 (71.9%) patients had chronic Charcot arthropathy. Deficiency was defined as <20 ng/ml, insufficiency was 20-29 ng/ml, and sufficient was > or = to 30 ng/ml. The average vitamin D level among all patients was 20.86 ± 7.8 ng/mL (range 8–39 ng/mL), with 27 patients (47.4%) who were vitamin D deficient, 21 patients (36.8%) who were vitamin D insufficient, and 9 patients who were (15.8%) vitamin D sufficient. 84.2% were either insufficient or deficient in vitamin D.
Conclusions: In this study, 84.2% of patients with Charcot arthropathy who visited the foot and ankle clinic over 4 years were vitamin D insufficient/deficient. Vitamin D could affect the pathogenesis of Charcot. As vitamin D is necessary for bone health and recovery, it may be beneficial to optimize during surgical and nonsurgical management of patients with Charcot. Many factors contribute to Charcot, a larger sample sizes and with multiple varaite analysis would help strengthen the argument for vitamin D deficiency as a an associated risk factor for Charcot arthropathy. Additonally, there may be benefit to evaluate how vitamin D intake as therapy would affect the outcomes of Charcot in future studies.