Prevalence of 25-hydroxyvitamin D deficiency in the acute inpatient rehabilitation population and its effect on function.

OBJECTIVES: To assess the prevalence of 25-hydroxyvitamin D (25[OH]D) insufficiency and deficiency in the acute inpatient rehabilitation setting, identify risk factors associated with low serum 25(OH)D levels, and assess whether hypovitaminosis D affects the function of rehabilitation patients. DESIGN: Retrospective cohort study. SETTING: Academic acute rehabilitation facility. PARTICIPANTS: Patients (N=101) admitted for acute inpatient rehabilitation between September 2008 and December 2008. INTERVENTIONS: Serum 25(OH)D levels drawn within 24 hours of admission. MAIN OUTCOME MEASURES: 25(OH)D level, total/motor/cognitive FIM efficiency. RESULTS: Considering patients not receiving 25(OH)D supplementation at the time of admission, 23.0% were 25(OH)D sufficient, 68.9% were insufficient, and 8.1% were deficient. Patients receiving 25(OH)D supplementation at the time of admission had significantly higher 25(OH)D levels than patients not receiving 25(OH)D supplementation (33.4±12.8 vs 23.7±11.4ng/mL; P=.001). A total of 72.2% of patients with any fracture and 80.0% of patients with fracture due to fall were not receiving supplementation at the time of admission; 72.2% of patients with any fracture and 73.3% of patients with fracture due to fall were 25(OH)D insufficient. Unadjusted total FIM efficiency scores were statistically significantly different by 25(OH)D status (2.96±1.42 vs 2.29±1.41ng/mL; P=.039). However, 25(OH)D level was not a significant predictor of total FIM efficiency score after controlling for demographic and clinical factors. CONCLUSIONS: Of acute rehabilitation patients, 77% are 25(OH)D insufficient or deficient at admission. 25(OH)D supplementation is associated with a greater 25(OH)D level in these patients; however, almost half those supplemented had 25(OH)D levels less than the reference range. Most inpatients with fracture due to fall were transferred to acute inpatient rehabilitation without 25(OH)D supplementation despite clear guidelines indicating its use in this situation.

Prevalence of 25-hydroxyvitamin D deficiency in the outpatient rehabilitation population.

OBJECTIVE: To assess the prevalence of 25-hydroxyvitamin D insufficiency and deficiency in the outpatient rehabilitation setting and to identify patient characteristics associated with low serum 25-hydroxyvitamin D levels. DESIGN: 25-Hydroxyvitamin D levels from 136 rehabilitation outpatients at an academic rehabilitation facility obtained from April 2007 to December 2008 for patient care purposes were captured via retrospective electronic medical record review. RESULTS: Considering only those subjects not receiving 25-hydroxyvitamin D supplementation at time of evaluation, 33.0% were 25-hydroxyvitamin D Sufficient while 53.2% were Insufficient and 13.8% Deficient. Those outpatient subjects receiving supplementation at time of evaluation had significantly higher 25-hydroxyvitamin D levels compared with those not receiving supplementation (34.1 ± 14.2 ng/ml vs. 25.9 ± 15.2 ng/ml; P = 0.005). Blacks had significantly lower 25-hydroxyvitamin D levels compared with whites (18.0 ± 10.6 ng/ml vs. 31.3 ± 14.3 ng/ml; P < 0.001). Subjects not on vitamin D supplementation assigned to diagnostic groups, Spinal Cord Injury, Brain Injury, and Hereditary Musculoskeletal, all had average 25-hydroxyvitamin D levels well below the lower limit of Sufficiency. CONCLUSIONS: Sixty-seven percent of rehabilitation outpatients are 25-hydroxyvitamin D Insufficient or Deficient. Supplementation significantly affects 25-hydroxyvitamin D levels in the outpatient rehabilitation population. Non-white race and history of Spinal Cord Injury, Brain Injury, or Hereditary Musculoskeletal diagnosis seem to be associated with lower 25-hydroxyvitamin D levels.