[Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism].

BACKGROUND: Primary hyperparathyroidism (PHPT) is a endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) from parathyroid gland tumors. Parathyroidectomy (PTE) is the main treatment for PHPT, but it can lead to hypocalcemia in up to 46% of cases. Hypocalcemia is associated with seizures and life-threatening cardiac arrhythmias, and vitamin D deficiency can exacerbate PHPT severity and contribute to «hungry bones syndrome,¼ resulting in severe and persistent postoperative hypocalcemia. AIM: To evaluate the association and determine the strength of the relationship between preoperative cholecalciferol therapy and the occurrence of hypocalcemia within 1-3 days after PTE in patients with PHPT. MATERIALS AND METHODS: The study was conducted at the Endocrinology Research Centre, during the periods of 1993-2010 and 2017-2020. The inclusion criteria consisted of patients diagnosed with PHPT who required PTE, had a serum 25-hydroxyvitamin D (25(OH)D) level below 20 ng/mL, and a serum total calcium level below 3 mmol/L. The exclusion criterion was the use of medications that affect calcium-phosphorus metabolism, including cinacalcet, denosumab, or bisphosphonates, either as monotherapy or as part of combination therapy. RESULTS: There were 117 patients, including 110 (94%) females and 7 (6%) males. The median age and interquartile range were 58 [49; 65] years. Among the participants, 21 (18%) received cholecalciferol supplementation for a duration of 2 weeks to 2 months prior to PTE, aiming to address vitamin D deficiency. The remaining 96 (82%) participants did not receive -cholecalciferol supplementation. Both groups, i.e., participants receiving cholecalciferol and those who did not, were similar in terms of anthropometric factors (sex and age at the time of surgery), preoperative clinical characteristics (BMD decrease), and laboratory parameters (PTH, total calcium, phosphorus, ALP, OC, CTX-1, and 25(OH)D levels). The occurrence of postoperative hypocalcemia was significantly lower in participants who received cholecalciferol supplementation (10% vs. 63%, p<0,001, FET2). Cholecalciferol intake showed a negative association with hypocalcemia development (RR=0,15, 95% CI (0,03; 0,51)). CONCLUSION: Preoperative cholecalciferol supplementation for 2 weeks to 2 months before PTE reduces the risk of postoperative hypocalcemia in patients with PHPT by 2-33 times.

Bilateral Femoral Neck Fracture Following an Epileptic Seizure in a Patient with Severe Vitamin D Deficiency: A Case Report.

Simultaneous bilateral femoral neck fractures represent a rare entity and are usually associated with bone metabolism disorders, chronic steroid treatment, epileptic convulsions, or high-energy trauma. Here we report a case of bilateral femoral neck fracture in a patient with severe vitamin D deficiency following an epileptic seizure. Anteroposterior and lateral radiographs of the pelvis revealed Garden III femoral neck fractures on both hips. A single-stage operation involving bilateral uncemented bipolar hemiarthroplasties using the anterolateral approach was performed. Three months postoperatively, the patient was able to ambulate independently. Simultaneous bilateral femoral neck fractures following an epileptic seizure is a rare injury. In our case, severe vitamin D deficiency and chronic use of antiepileptics predisposed the patient to this condition. Orthopaedic surgeons and other clinicians should be aware of such an uncommon pathology. A multidisciplinary team approach is essential in identifying risk factors and optimizing inpatient management and postoperative rehabilitation. A single-stage bilateral procedure with an uncemented bipolar hip hemiarthroplasty in order to reduce cement disease in this frail patient has been successful in restoring functional capacity and allowing the patient to return to his preinjury ambulatory status.

Effects of vitamin D deficiency on the improvement of metabolic disorders in obese mice after vertical sleeve gastrectomy.

Vertical sleeve gastrectomy (VSG) is one of the most commonly performed clinical bariatric surgeries for the remission of obesity and diabetes. Its effects include weight loss, improved insulin resistance, and the improvement of hepatic steatosis. Epidemiologic studies demonstrated that vitamin D deficiency (VDD) is associated with many diseases, including obesity. To explore the role of vitamin D in metabolic disorders for patients with obesity after VSG. We established a murine model of diet-induced obesity + VDD, and we performed VSGs to investigate VDD's effects on the improvement of metabolic disorders present in post-VSG obese mice. We observed that in HFD mice, the concentration of VitD3 is four fold of HFD + VDD one. In the post-VSG obese mice, VDD attenuated the improvements of hepatic steatosis, insulin resistance, intestinal inflammation and permeability, the maintenance of weight loss, the reduction of fat loss, and the restoration of intestinal flora that were weakened. Our results suggest that in post-VSG obese mice, maintaining a normal level of vitamin D plays an important role in maintaining the improvement of metabolic disorders.

Effect of vitamin D nutrition on disease indices in patients with primary hyperparathyroidism.

In patients with primary hyperparathyroidism, the size of the adenoma is a major determinant of biochemical indices, disease severity, and manner of presentation. However, the large variation in adenoma weight, both within and between populations and a steady decline in parathyroid adenoma weights over time remain largely unexplained. Based on the results in a small number of patients almost two decades ago we proposed that vitamin D nutritional status of the patient explains both the disease manifestations and much of the variation in adenoma size. Accordingly, we examined the relationship between vitamin D nutrition, as assessed by serum levels of 25-hydroxyvitamin D, and parathyroid gland weight, the best available index of disease severity, in a large number of patients (n = 440) with primary hyperparathyroidism. A significant inverse relationship was found between serum 25-hydroxyvitamin D level and log adenoma weight (r = -0.361; p < 0.001). Also, the adenoma weight was significantly related directly to serum PTH, calcium, and alkaline phosphatase as dependent variables. In patients with vitamin D deficiency (defined as serum 25-hydroxyvitamin D levels 15 ng/mL or lower), gland weight, PTH, AP, and adjusted calcium were each significantly higher than in patients with 25-hydroxyvitamin D levels of 16 ng/mL or higher, but serum 1,25-dihydroxyvitamin D levels were similar in both groups. We interpret this to mean that suboptimal vitamin D nutrition stimulates parathyroid adenoma growth by a mechanism unrelated to 1,25-dihydroxyvitamin D deficiency. We conclude that variable vitamin D nutritional status in the population may partly explain the differences in disease presentation.

The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery.

STUDY DESIGN: This is a retrospective cohort comparative study. BACKGROUND: Vitamin D supplementation is considered to be associated with good functional outcome. Thus, a few studies have proposed vitamin D supplementation is benefit to the functional outcome in LSS requiring surgery. The purpose of this study is to identify the prevalence of vitamin D deficiency in patients with LSS requiring surgery, and to compare the differences between the cases whether vitamin D is supplemented and vitamin D is not supplemented in terms of a QoL during postoperative 2 year. METHODS: All patients with LSS who underwent surgery from March 1, 2015 to August 31, 2016 were enrolled. Among them, 61 patients with vitamin D deficiency were divided into two groups (supplemented group (A) and non-supplemented group (B)). Functional outcomes using Oswestry Disability Index (ODI) and Rolland Morris Disability Index (RMDQ) and QoL using SF-36 were evaluated at 12-month and 24-month follow-up periods. Differences in functional score and SF-36 between the vitamin D supplemented and non-supplemented group were compared. RESULTS: Among the total 102 patients, 78 patients (76.5%) had vitamin D deficiency. Of the 78 patients, 61 patients were included, 27 patients were group A and 27 patients were group B. There was no difference in age and 25-OHD level between the two groups (all 0 > 0.05). Group A were better functional outcomes at 2 years after surgery (p < 0.05). On the QoL, group A were higher score than group B from 12 month later after surgery (p < 0.05). CONCLUSIONS: Vitamin D deficiency was highly prevalent in LSS patients (76.5%). Assessment of serum 25-hydroxyvitamin D (25(OH)D) is recommended in LSS needing surgical intervention and active treatment vitamin D supplementation and maintenance of normal range should be considered for better postoperative functional outcome and QoL.

Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism.

BACKGROUND: Intraoperative monitoring of parathyroid hormone (IOPTH) is a reliable method of predicting the cure of primary hyperparathyroidism (PHPT). The aim of this study is to assess whether common clinical variables (CCV) frequently encountered in patients with PHPT may affect the magnitude of PTH drop or the likelihood of patients meeting the intraoperative cure criterion. DESIGN: Patients who were surgically cured from PHPT caused by single gland disease (SGD) and had full IOPTH protocol (4 measurements) were stratified according to age, gland weight, renal function, vitamin D status and severity of hypercalcemia. The percentage of IOPTH drop and the frequency of patients who had true positive IOPTH test results were compared among groups. RESULTS: 762 patients had surgery for PHPT, of whom 746 were (98%) cured. Of these 746 patients, 511 who had SGD and a full IOPTH protocol were included in this study. The median IOPTH drop was significantly higher among younger patients, those with severe hypercalcaemia at 5, 10, 15 min after gland excision, giant glands (at 5-min only), patients with vitamin D deficiency (at 10, 15 min), and those with normal renal function (at 15 min only). The likelihood of the patients meeting the intraoperative cure criterion was not significantly affected among the groups except in patients with mild hypercalcaemia, who were significantly less likely to have 50% IOPTH drop than those with severe hypercalcaemia at all time points. The frequency of mildly hypercalcaemic patients who met cure criterion was significantly improved by extending measurement to 15 min. CONCLUSIONS: IOPTH monitoring has the ability to mitigate the variability of IOPTH kinetics associated with most clinical variables. Mildly hypercalcemic patients in particular may benefit from waiting for 15-min measurement before any surgical decision is made.

The Effect of Serum 25(OH)D3 Level on Breast Cancer-Related Lymphedema.

Background: The aim of this study was to evaluate the effect of serum 25-hydroxyvitamin D3 [25(OH)D3] levels on the presence and severity of lymphedema, and on the levels of pain, disability, and function in patients with breast cancer-related lymphedema (BCRL). Methods and Results: This controlled study included 71 patients diagnosed with breast carcinoma. Participants were divided into two groups. The BCRL group included 37 breast cancer patients with lymphedema and the control group included 34 breast carcinoma patients without lymphedema. Demographic information, dominant extremity, affected breast, duration of malignancy, and serum 25(OH)D3 levels were recorded for all patients. The 25(OH)D3 levels were then compared between groups. The correlations between serum 25(OH)D3 levels and the visual analog scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH) scales and the volumetric and diametric differences between the upper extremities were analyzed in the BCRL group. Serum 25(OH)D3 levels did not show statistically significant differences between groups (p > 0.05). There was no correlation in the BCRL group between 25(OH)D3 levels and the VAS and Q-DASH scores or the diametric and volumetric differences of extremities (r ≤ 0.3; p > 0.05). Conclusions: Serum 25(OH)D3 levels do not appear to affect the presence or severity of lymphedema, pain, disability, or physical function in BCRL patients. In routine clinical practice, evaluation of this vitamin level does not appear to be necessary for lymphedema in BCRL patients.

Surgical Considerations in Managing Osteoporosis, Osteopenia, and Vitamin D Deficiency During Arthroscopic Rotator Cuff Repair.

Osteopenia and osteoporosis are common in older adults and are associated with increased risk of fragility fractures. Vitamin D deficiency caused by chronic disease, poor nutrition, and inadequate sun exposure affects bone quality. Chronic rotator cuff tears can deteriorate the bone mineral density of the greater tuberosity and have been linked to reduced anchor pullout strength and high re-tear rate after repair especially in older patients with larger tear size. This article summarizes the current evidence on rotator cuff tear and bone quality and provides treatment strategies for rotator cuff repair in patients with poor bone quality.

Is There Association between Vitamin D Concentrations and Body Mass Index Variation in Women Submitted to Y-Roux Surgery?

Objective: To evaluate vitamin D deficiency and body composition of women submitted to bariatric surgery and relate their body mass index variation after surgery to 25(OH)D concentrations. Method: A cross-sectional and controlled study was performed including 49 obese adult volunteer women, submitted to Roux-en-Y gastric bypass (RYGB group). Collected Data: Body mass index (BMI), self-declared ethnicity, economic condition, physical activity level, serum concentrations of 25-hydroxycholecalciferol (25(OH)D; radioimmunoassay), parathormone, and body composition by dual-energy X-ray absorptiometry (Hologic DXA-QDR-1000) were collected. Results: 25(OH)D deficiency was found in 27 (55.1%) and 8 (21.1%) in the RYGB and control groups (p=0.002). Secondary hyperparathyroidism was more frequent in the RYGB group compared to the control group (15 (30.6%) versus 1 (2.6%); p=0.001). There was no relation of the studied variables and body composition with 25(OH)D deficiency. 25(OH)D concentrations were correlated (r=-0.531; p < 0.001) with BMI reduction, regardless of vitamin D supplementation. Conclusion: Women submitted to bariatric surgery (RYGB) around three years ago had higher BMI and vitamin D deficiency, along with hyperparathyroidism, compared to the control group. There was no association between variables related to body composition and 25(OH)D concentrations. On the other hand, vitamin concentrations correlated negatively to BMI variation after undergoing surgery.

[Risk factors generally neglected in oral surgery and implantology: the high LDL-cholesterol and the insufficient level of vitamin D]. / Des facteurs de risque généralement négligés en chirurgie orale et en implantologie : le taux élevé de LDL-cholestérol et le taux insuffisant de la vitamine D.

INTRODUCTION: Vitamin D deficiency is widespread throughout the world. Vitamin D has an important role in the regulation of phosphocalcic metabolism as well as in a large number of biological and metabolic processes. According to some studies, there is a correlation between vitamin D and LDL-cholesterol levels. A deficiency of vitamin D and / or a high level of LDL-cholesterol could represent risk factors for bone healing and osteointegration of dental implants. The purpose of our study is to demonstrate the reality of the problem of deficiency or deprivation in vitamin D in a population of patients requiring oral and / or implant surgery. MATERIAL AND METHODS: 46 cases of patients having undergone oral surgery together with preoperative blood test were analyzed. The results of the dosages of 25-hydroxy-vitamin D (25-OH-D), total cholesterol, LDL-cholesterol, HDL-cholesterol were collected and compared with reference values. Statistical tests were performed to determine the possible correlations between the 25-OH-D level and other blood parameters. RESULTS: 38 patients out of 46 (82.6 %) are defective in vitamin D, and 7 patients out of 46 (15.2 %) are deficient. LDL-cholesterol levels were high in 15 patients out of 33 (45.5 %). There was a non-significant correlation between LDLcholesterol and vitamin D levels. Total cholesterol was high in 42 % of patients. We observed a significant correlation between total cholesterol and vitamin D levels. CONCLUSION: According to our study, it appears that a preoperative assessment including the dosage of vitamin D, total cholesterol and LDLcholesterol may be of interest in patients requiring oral and / or implant surgery by correcting if necessary blood parameters and promoting bone metabolism.

INTRODUCTION: La déficience en vitamine D est largement répandue dans le monde. Or la vitamine D a un rôle important dans la régulation du métabolisme phosphocalcique ainsi que dans un grand nombre de processus biologiques et métaboliques. Selon certaines études, il existerait une corrélation entre le taux de vitamine D et le taux de LDL-cholestérol. Une déficience en vitamine D et/ou un taux élevé de LDL-cholestérol pourraient représenter des facteurs de risques de cicatrisation osseuse et d'ostéointégration d'implants dentaires. Le but de notre étude est d'objectiver, dans une population de patients devant bénéficier d'une chirurgie orale et/ou implantaire, la réalité du problème de déficience ou de carence en vitamine D. Matériel et méthode : 46 dossiers de patients ayant bénéficié d'une intervention chirurgicale buccodentaire et d'une prise de sang ont été analysés. Les résultats du dosage de 25-hydroxyvitamine D (25-OH-D), cholestérol total, LDL-cholestérol, HDL-cholestérol ont été recueillis et comparés aux valeurs de références. Des tests statistiques ont été réalisés afin d'établir les corrélations éventuelles entre le taux de 25-OH-D et les autres paramètres sanguins. Résultats : 38 patients sur 46 (82,6 %) sont déficients en vitamine D, et 7 patients sur 46 (15,2 %) sont carencés. Le taux de LDLcholestérol est élevé chez 15 patients sur 33 (45,5 %). Il existe une corrélation non significative entre le taux de LDL-cholestérol et le taux de vitamine D. Le taux de cholestérol total est élevé chez 42 % des patients. Nous observons une corrélation significative entre le taux de cholestérol total et le taux de vitamine D. CONCLUSION: D'après notre étude, il apparaît qu'un bilan préopératoire incluant le dosage de la vitamine D, du cholestérol total et du LDLcholestérol pourrait s'avérer intéressant afin de corriger si nécessaire ces paramètres sanguins et favoriser le métabolisme osseux dans un contexte de chirurgie orale et/ou implantaire.

Pre-operative localization of abnormal parathyroid tissue by 99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency.

CONTEXT: Accurate preoperative localization of abnormal parathyroid tissue aids importantly in minimally invasive parathyroidectomy in patients with primary hyperparathyroidism. Vitamin D deficiency may possibly influence the success and characteristics of pre-operative localization because it is associated with more active disease and possibly larger adenomas. This could increase the sensitivity of the sestamibi to identify abnormal parathyroid tissue, but earlier reports are conflicting. Vitamin D deficiency could also influence the nature of preoperative localization because it could lead to multi-gland stimulation of parathyroid tissue giving an appearance of multi-gland disease, which may lower accuracy of preoperative localization with sestamibi. OBJECTIVE: To examine the relationship between vitamin D deficiency and correct parathyroid tissue localization by four-pole thyroid quadrant analysis. DESIGN: Retrospective study. SETTING: Referral center. PARTICIPANTS: A total of 138 patients were divided into three groups according to the level of 25OHD; <20 ng/mL (vitamin D deficient), ≥20 to <30 ng/mL (vitamin D insufficient) and ≥30 ng/mL (vitamin D replete). MAIN OUTCOMES: Quadrant localization using 99mTc-sestamibi/SPECT. RESULTS: Among those with single-gland disease, the proportion of patients with correct quadrant localization were 60.0, 68.3 and 63.5% (p = 0.778), and the accuracy of sestamibi was 89.3, 90.6 and 89.9% for the deficient, insufficiency and replete groups, respectively. Among those with multi-gland disease, the proportion of patients with correct quadrant localization were 50.0, 25.0 and 18.2% (p = 0.619) while the accuracy was 50.0, 50.0 and 45.5%, respectively. Multi-gland disease did not occur more frequently in any of the three groups (p = 0.296). CONCLUSIONS: Vitamin D levels do not affect the accuracy of preoperative localization with sestamibi.

Pneumosinus dilatans of the spheno-ethmoidal complex associated with hypovitaminosis D causing bilateral optic canal stenosis.

INTRODUCTION: Pneumosinus dilatans (PSD) is a rare disorder of undetermined etiology characterized by expansion of the paranasal sinuses without bony erosion. Of the few cases of PSD described in indexed pediatric literature, there has been no reported case of this disorder presenting with optic canal stenosis in the setting of a vitamin deficiency. CASE MATERIAL: A 12-year-old girl presented with a 3-month history of progressive, painless, and asymmetric visual deterioration in her eyes. MRI showed prominent perioptic CSF spaces bilaterally and mild atrophy of both the optic nerves. CT head showed hyperpneumatization of the sphenoethmoidal air cells and both anterior clinoid processes with the optic nerves contained within narrowed intact bony canals. Blood investigations showed reduced vitamin D levels, and a subsequent skeletal survey showed diffuse osteopenia. She underwent endoscopic sphenoidotomy and bilateral decompression of the optic nerves. Following surgery, she reported improvement of vision in her left eye. She was started on vitamin D supplements for the endocrine abnormality. At a follow-up visit 6 months later, her visual acuity in both her eyes had improved. CONCLUSION: Pneumosinus dilatans is an unusual cause of progressive optic nerve dysfunction in the pediatric population. In the absence of any associated intracranial pathologies, conditions like hypovitamosis D should be ruled out.

Circulating interleukin-6 is not altered while γ-tocopherol is increased in subjects scheduled for knee surgery with low vitamin D.

The purpose of this study was to identify if circulating interleukin (IL)-6 and γ-tocopherol (γT) fluctuate with vitamin D status in subjects with an underlying knee joint injury or disease. We hypothesized that low vitamin D associates with an increase in plasma γT while serum IL-6 remains unchanged in subjects with an underlying knee joint trauma or disease. Fifty-four subjects scheduled to undergo primary, unilateral anterior cruciate ligament reconstructive surgery (ACL; n=27) or total knee arthroplasty (TKA; n=27) were studied. Circulating γT, α-tocopherol (αT), lipids (cholesterol and triglycerides), IL-6, and 25-hydroxyvitamin D (25(OH)D) were measured in fasting blood samples obtained prior to surgery. Subjects were classified as vitamin D deficient, insufficient, or sufficient if they had a serum 25(OH)D concentration <50, 50-75, or >75nM, respectively. The majority (57%) of the subjects possessed a serum 25(OH)D less than 50nM. Circulating cholesterol, triglycerides, and IL-6 were not significantly (all p>0.05) different between vitamin D status groups. However, lipid corrected αT was significantly (p<0.05) decreased and both lipid- and non-lipid-corrected plasma γT concentrations were significantly (both p<0.05) increased with low serum 25(OH)D (i.e., <50nM). A significant (p<0.05) multi-variate analysis revealed that an increase in plasma γT per lipids was significantly (p<0.05) predicted by a decrease in serum 25(OH)D but not by a decrease in plasma αT per lipids. We conclude that low vitamin D associates with an increase in plasma γT but not IL-6 in subjects with an underlying joint injury or disease.

VITAMIN D DEFICIENCY DOES NOT AFFECT THE LIKELIHOOD OF PRESURGICAL LOCALIZATION IN ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM.

OBJECTIVE: Vitamin D deficiency (VDD) was previously associated with larger adenoma size in primary hyperparathyroidism (PHPT), but this topic was not addressed in patients with the mild/asymptomatic form of the disease (aPHPT). METHODS: We retrospectively retrieved from our series of patients affected by PHPT, 96 consecutive subjects with aPHPT in whom 25-hydroxyvitamin D (25OHD) levels had been assayed and compared those results with localizing imaging studies. RESULTS: Twenty-five of 96 patients had VDD (25OHD <20 ng/mL), but positive ultrasound and scintigraphic studies were not different between patients with and without VDD (52.3% versus 55.7% and 42.9% versus 52.4%, respectively). Upon logistic regression analysis, after adjusting for different variables, including the presence of goiter, VDD was not an independent predictor of localization by imaging studies. CONCLUSION: VDD does not affect the likelihood of positive pre-operative imaging in aPHPT and the consequent surgical decisions.

Vitamin D Deficiency in Slipped Upper Femoral Epiphysis: Time to Physeal Fusion.

BACKGROUND: Slipped upper femoral epiphysis (SUFE) has an incidence of 1 to 7 per 100,000 adolescents in the United Kingdom and its link with obesity is well established. With an increasing number of pediatric orthopaedic patients presenting with vitamin D deficiency, the aim of our study was to establish the prevalence of vitamin D deficiency in SUFE patients presenting to an orthopaedic department in the United Kingdom and whether a low vitamin D level increases the time to proximal femoral physeal fusion after surgical fixation. METHODS: A total of 27 pediatric patients, with a female to male ratio of 17:10 and a mean age of 11.5 years (SD=1.99), range 8 to 16 years, presented with a SUFE and their vitamin D level was assessed during the study period, June 2007 to July 2012 (inclusive). The majority of these patients (85.2%) were assessed as vitamin D deficient, with a serum 25-(OH)D<52 nmol/L. The time taken for >50% physeal fusion on anteroposterior radiography after surgical fixation reported in the literature is 9.6 months, with no reported vitamin D deficiency or insufficiency. RESULTS: In our study, the median time to physeal fusion in the vitamin D-deficient and vitamin D-insufficient patients was 25 months (interquartile range, 17 to 43 mo; mean of 29 mo, SD=16.8). A negative correlation was also observed between vitamin D level and the time taken for physeal fusion after surgical fixation. CONCLUSIONS: We conclude that a high prevalence of vitamin D deficiency has been observed in our SUFE patients. Comparing the time taken for physeal closure of 9.6 months in the literature with vitamin D-deficient patients, this is prolonged. Indeed, a negative correlation has been shown between vitamin D level and time to physeal fusion. This study highlights the need for regular vitamin D status assessment in SUFE patients to allow early implementation of treatment with vitamin D supplementation. The impact of vitamin D screening and supplementation on SUFE outcomes should be investigated further.

Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn's disease.

BACKGROUND: Vitamin D may have an immunologic role in Crohn's disease (CD) and ulcerative colitis (UC). Retrospective studies suggested a weak association between vitamin D status and disease activity but have significant limitations. METHODS: Using a multi-institution inflammatory bowel disease cohort, we identified all patients with CD and UC who had at least one measured plasma 25-hydroxy vitamin D (25(OH)D). Plasma 25(OH)D was considered sufficient at levels ≥30 ng/mL. Logistic regression models adjusting for potential confounders were used to identify impact of measured plasma 25(OH)D on subsequent risk of inflammatory bowel disease-related surgery or hospitalization. In a subset of patients where multiple measures of 25(OH)D were available, we examined impact of normalization of vitamin D status on study outcomes. RESULTS: Our study included 3217 patients (55% CD; mean age, 49 yr). The median lowest plasma 25(OH)D was 26 ng/mL (interquartile range, 17-35 ng/mL). In CD, on multivariable analysis, plasma 25(OH)D <20 ng/mL was associated with an increased risk of surgery (odds ratio, 1.76; 95% confidence interval, 1.24-2.51) and inflammatory bowel disease-related hospitalization (odds ratio, 2.07; 95% confidence interval, 1.59-2.68) compared with those with 25(OH)D ≥30 ng/mL. Similar estimates were also seen for UC. Furthermore, patients with CD who had initial levels <30 ng/mL but subsequently normalized their 25(OH)D had a reduced likelihood of surgery (odds ratio, 0.56; 95% confidence interval, 0.32-0.98) compared with those who remained deficient. CONCLUSION: Low plasma 25(OH)D is associated with increased risk of surgery and hospitalizations in both CD and UC, and normalization of 25(OH)D status is associated with a reduction in the risk of CD-related surgery.

Vitamin D insufficiency in patients with acute hip fractures of all ages and both sexes in a sunny climate.

OBJECTIVES: To determine the incidence of vitamin D deficiency in patients with hip fractures of all ages who live in the southwest United States. DESIGN: Retrospective comparative study. SETTING: Two level 2 trauma centers and 2 community hospitals in San Diego, CA. PATIENTS/PARTICIPANTS: Four hundred forty-eight patients who sustained a hip fracture from December 2010 to December 2011 and a control group of 1091 patients who underwent elective primary total hip or knee surgery during the same time period. MAIN OUTCOME MEASUREMENTS: Serum 25-hydroxyvitamin D (25(OH)D) levels. RESULTS: The mean 25(OH)D level for both the Hip Fracture (26.38 ng/mL) and Total Joint (29.92 ng/mL) Groups showed vitamin D insufficiency, with the Hip Fracture Group having lower levels (P < 0.05). More patients in the Hip Fracture Group were deficient or insufficient (65.8% vs. 54.0%, P < 0.05). Patients aged 71 years or older were more deficient or insufficient in the Hip Fracture Group than in the Total Joint Group (66.7% vs. 47.13%, P < 0.05). There was no difference when comparing males versus females (P > 0.05). Females in the Hip Fracture Group were more deficient or insufficient (67.3% vs. 54.3%, P < 0.05) than in the Total Joint Group. CONCLUSIONS: The majority of patients aged 18 years or older of both sexes with hip fractures had vitamin D insufficiency and those aged 71 years or older had significantly lower 25(OH)D levels than a control group of total joint patients. LEVEL OF EVIDENCE: Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

Intra-operative parathyroid hormone kinetics and influencing factors with high baseline PTH: a prospective study.

BACKGROUND AND OBJECTIVE: Intra-operative parathyroid hormone (IOPTH) kinetics and therefore the efficacy of IOPTH utilization as a predictor of cure are likely to be affected by baseline IOPTH levels, vitamin D deficiency and parathyroid weight. PATIENTS AND METHODS: Consecutive subjects with primary hyperparathyroidism (PHPT, n = 51) undergoing parathyroidectomy with IOPTH monitoring were studied prospectively during the period October 2009-November 2011. Samples were collected pre-incision, pre-excision and post-excision (5, 10, 15 min). Iterative analysis of IOPTH kinetics and half-life calculation was carried out in subgroups. Nonparametric testing was used for group statistics. RESULTS: Hypovitaminosis D (25(OH)D3 < 50 nm) was present in 39 (76%), serum PTH > 1000 ng/l in 23 (45%), and giant parathyroid adenoma (weight > 3000 mg) in 23 (45%). The percentage drop at 10 min was significantly higher in large adenomas (weight > 3000 mg). Miami and 5 min criteria showed the highest negative predictive value and maximum accuracy. The average percentage IOPTH drop observed at 5 min post-excision was 79.8%. Kinetic analysis showed a mean half-life of PTH of 2.57 ± 0.27 min (range: 0.07-11.55). CONCLUSION: IOPTH monitoring is reliable even in patients with extremely high baseline IOPTH value, with a greater percentage drop at 5 and 10 min post-excision. In patients with high baseline IOPTH, a 50% decay in PTH value at 5 min may be indicative of cure, obviating the need for 10 and 15 min samples. IOPTH kinetics are altered by adenoma weight but not affected by vitamin D status or baseline IOPTH levels.