How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

Chevalley, T.; Brandi, M.L.; Cavalier, E.; Harvey, N.C.; Iolascon, G.; Cooper, C.; Hannouche, D.; Kaux, J.-F.; Kurth, A.; Maggi, S.; Maier, G.; Papavasiliou, K.; Al-Daghri, N.; Sosa-Henríquez, M.; Suhm, N.; Tarantino, U.; Reginster, J.-Y.; Rizzoli, R.

In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.