Vitamin D3 provides no healing benefits for patients with tibia and femur fractures
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Vitamin D3 supplementation showed no improvement in clinical or radiographic fracture healing in adult patients who underwent intramedullary nailing for a tibial or femoral shaft fracture, according to presented results.
“Vitamin D deficiency is prevalent amongst healthy, adult fracture patients,” Gerard P. Slobogean, MD, an associate professor at the R Adams Cowley Shock Trauma Center at the University of Maryland School of Medicine, said in his presentation at the Orthopaedic Trauma Association Annual Meeting, which was held as a virtual event.
“Currently, we are aware of a strong association between vitamin D deficiency and nonunion. Many surgeons advocate using vitamin D supplements to improve acute fracture healing because it is safe, cheap and may possibly work.” Slobogean said. “However, data to support that supplementation improves fracture healing is lacking.”
Slobogean and colleagues analyzed 99 patients with closed or type 1/2 open tibial or femoral shaft fractures treated with a reamed, locked intramedullary nail. Researchers categorized patients into four, double-blinded treatment groups: a high-loading dose group (150,000 IU at injury and 6 weeks); a high daily dose group (4,000 IU daily); a low daily dose group (600 IU daily); and a placebo group. Daily and placebo supplements were given for 3 months.
According to the study, primary outcome measures included radiographic healing scores, using the Radiographic Union Scale in Tibial Fractures (RUST), and clinical healing scores, using the Function Index for Trauma (FIX-IT). Investigators also measured serum 25(OH)D levels. He noted 56% of patients were vitamin D deficient at baseline.
According to results at 3 months, RUST and FIX-IT scores remained consistent throughout each of the four cohorts. The high-loading dose group had a RUST score of 11 and FIX-IT score of 10.1. The high daily dose group had a RUST score of 11.3 and FIX-IT score of 9.7, the low daily dose group had a RUST score of 11 and FIX-IT score of 9.3 and the placebo group had a RUST score of 10.4 and FIX-IT score of 9.
Slobogean noted that while vitamin D3 supplementation was successful in raising serum 25(OH)D levels, “it’s clinical significance remains uncertain.”
“We were unable to identify any treatment benefits across the three treatment strategies,” he concluded. “Our data does not support the routine use of supplements to improve fracture healing, although other indications for its routine use may still be considered.”
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Slobogean GP, et al. Vitamin D3 supplementation does not improve fracture healing: A double-blinded randomized controlled trial. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20-24, 2020 (virtual meeting).
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