SLR - September 2022 - Danny Ghannoum, DPM
Reference: Maier GS, Weissenberger M, Rudert M, Roth KE, Horas K. The role of vitamin D and vitamin D deficiency in orthopaedics and traumatology-a narrative overview of the literature. Ann Transl Med. 2021 Jun;9(11):942. doi: 10.21037/atm-21-779. PMID: 34350257; PMCID: PMC8263860.Level of Evidence: Level V
Scientific Literature Review
Reviewed By: Danny B. Ghannoum, DPM
Residency Program: Saint Vincent Hospital – Worcester, MA
Podiatric Relevance: This narrative review provides a comprehensive investigation of the properties of vitamin D as it relates to musculoskeletal health, as well as a review of the recent literature reporting on the prevalence of vitamin D deficiency and it’s correlation with traumatology, oncology, and orthopedic diseases.
Methods: This was a narrative overview of the literature. 128 recent articles deemed as substantial contributions on the subject were reviewed. Articles discussing the properties of Vitamin D and how vitamin D , vitamin D deficiency, and vitamin D receptors (VDR) impact musculoskeletal health were included. Articles regarding vitamin D deficiency in traumatology, orthopaedic diseases, and bone oncology were also included.
Results: Vitamin D and bone metabolism: Vitamin D is essential in maintaining a well-balanced metabolism within the bone microenvironment. Vitamin D levels below 20 ng/mL lead to malabsorption of intestinal calcium which in turn may cause osteomalacia in adults and rickets in children.
Vitamin D and fracture prevention: Vitamin D serum levels may serve as an indicator for hip fracture risk. Vitamin D deficiency in postmenopausal women is associated with osteoporotic vertebral fractures. Serum vitamin D levels under 20 ng/mL doubled the risk of osteoporotic fractures compared to levels above this threshold. Vitamin D supplements may reduce the risk of fractures due to an increase in bone mineral density and via reductions of falls.
Vitamin D and fracture healing: Vitamin D regulates a range of genes involved in bone remodeling after a bone fracture. Vitamin D deficiency can impair IL-4 and IL-13 production negatively impact fracture healing, contributing to nonunion of fractures.
Vitamin D in Orthopaedics: Orthopaedic diseases associated with alterations of bone metabolism such as bone marrow edema syndrome and osteochondritis dissecans have been linked to low vitamin D levels. Low vitamin D levels have been associated with an increased risk for muscle injuries and tendinopathy.
The impact of vitamin D on osteoarthritis and arthroplasty: Vitamin D deficiency is associated with increased risk for the progression of osteoarthritis of the knee. Vitamin D can attenuate inflammation and fatty infiltration, and protect the architecture of the cartilage tissue. Vitamin D supplementation does not reduce cartilage volume loss in patients with knee osteoarthritis. Additional studies are needed to correlate clinical relevance.
Vitamin D in bone oncology: Vitamin D possesses direct anti-cancer actions by attenuating cancer cell proliferation while promoting differentiation and apoptosis. Vitamin D can indirectly impact cancer growth in bone by altering changes in the bone microenvironment. Alterations within the bone microenvironment due to low vitamin D levels may result in an increased skeletal susceptibility to cancer metastasis.
Conclusions: There is a plethora of research substantiating the beneficial health-effects of vitamin D in orthopaedics, traumatology, and bone oncology. Further research should be performed to assess for clinical relevance and ambiguity. Clinicians should be aware of the high prevalence of vitamin D deficiency in orthopaedic, trauma, and oncology patients. A closer monitoring of vitamin D status may be beneficial and vitamin D supplements should be considered for patients with insufficient vitamin D status.