The aims were to assess whether vitamin D deficiency influenced mortality risk for patients presenting with a hip fracture. A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels were assessed. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for confounding) was utilised to determine the independent association between serum vitamin D level and patient mortality. The cohort consisted of 2075 patients with a mean age of 80.7 years and 1471 (70.9%) were female. 1510 (72.8%) patients had a serum vitamin D level taken, of which 876 (58.0%) were deficient (<50nmol/l). The median follow up was 417 (IQR 242 to 651) days. During follow up there were 464 (30.7%) deaths. Survival at 1 year was significantly (p = 0.003) lower for patients who were vitamin D deficient (71.7%, 95% confidence intervals (CI) 68.6 to 74.9) compared to those who were not (79.0%, 95% CI 75.9 to 82.3). Vitamin D deficiency was also independently associated with an increased mortality risk at 2-years (HR 1.42, 95% CI 1.17 to 1.71, p = 0.03), but not at 1-year (p = 0.08). Hip fracture patients with vitamin D deficiency had an increased mortality risk. This risk was independent of confounders at 2 years. The role of measuring vitamin D levels in these patients is unclear. Improved public health policy about vitamin D may be required to reduce deficiency in this patient population

The aims were to assess whether vitamin D deficiency influenced mortality risk for patients presenting with a hip fracture. A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels were assessed. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for confounding) was utilised to determine the independent association between serum vitamin D level and patient mortality. The cohort consisted of 2075 patients with a mean age of 80.7 years and 1471 (70.9%) were female. 1510 (72.8%) patients had a serum vitamin D level taken, of which 876 (58.0%) were deficient (50nmol/l). The median follow up was 417 (IQR 242 to 651) days. During follow up there were 464 (30.7%) deaths. Survival at 1 year was significantly (p=0.003) lower for patients who were vitamin D deficient (71.7%, 95% confidence intervals (CI) 68.6 to 74.9) compared to those who were not (79.0%, 95% CI 75.9 to 82.3). Vitamin D deficiency was also independently associated with an increased mortality risk at 2-years (HR 1.25, 95% CI 1.03 to 1.53, p=0.025), but not at 1-year (p=0.057). Hip fracture patients with vitamin D deficiency had an increased mortality risk. This risk was independent of confounders at 2 years. The role of measuring vitamin D levels in these patients is unclear. Improved public health policy about vitamin D may be required to reduce deficiency in this patient population

Introduction:. Vitamin D plays an important role in bone turnover. Deficiency (including borderline deficiency, or insufficiency) has a known association with fractures and has been linked to delayed or nonunion of fractures. We therefore routinely test vitamin D in cases of nonunion. Noting a high rate of vitamin D deficiency in this group, we instituted a policy to routinely screen for and treat vitamin D deficiency in both post-operative and pre-operative patients. We hypothesised that, in the post-operative patients, levels would correlate with rates of union. Methods:. We sent serum vitamin D levels on consecutive post-operative patients seen in clinics between January and May 2014. They included those with an arthrodesis of the ankle, triple joint or first MTPJ. Union was deemed to have occurred when the patient was comfortable full weight bearing and radiographs showed trabeculae crossing the fusion site. Nonunions were all confirmed with computed tomography. Results:. Ten patients were treated for nonunion, and had a mean serum vitamin D of 58nmol/L. Fourteen patients (collected over a shorter time period) had confirmed union, with a mean vitamin D of 90nmol/L. This was statistically significant on a one tailed Student's t test (p=0.038). Vitamin D was deficient in five (50%) of nonunions and in three (21%) of unions, giving an odds ratio of 3.67. Conclusions:. Our early results show a significant association of serum vitamin D levels with likelihood of nonunion, and we continue to collect data. There is a high prevalence of vitamin D deficiency in our patient population. This is of concern both for the outcome of their surgery and for their lifetime fracture risk. We recommend either screening for or presumptively treating vitamin D deficiency

Femoral head deformity can be a devastating outcome in a small percentage of patients with Perthes' disease. Deformities usually start during the fragmentation stage. In this study, we aimed to determine the effects of Vitamin D deficiency on the natural history of Perthes' disease. Patients with Perthes' disease and Vitamin D deficiency presenting to our unit in the last 3 years were identified. All X-rays were reviewed retrospectively to determine the duration of the fragmentation and ossification stages. Treatment methods were obtained from the notes. Late presenters (i.e. after fragmentation stage) were excluded. In our unit, Vitamin D deficiency is diagnosed if levels <72 nmol/L. Fifteen patients (17 hips) with Perthes' disease were found to be Vitamin D deficient. Levels ranged from (18–71 nmol/L). The mean length of the fragmentation stage was 15.7 months which is significantly higher than quoted literature figures (8 months). Ossification stage duration was 18.8 months which was comparable to quoted figures. However, patients with severe Vitamin D deficiency (< 52 nmol/L) were found to have longer ossification stage (20.6 months) compared with patients with mild deficiency (52–72 nmol/L) (16.4 months). Seven out of 16 patients (44%) required surgical containment which is significantly higher than the usually low rates of surgical intervention. The critical fragmentation stage in Vitamin D deficiency is significantly longer putting the femoral head at higher risk of deformity and extrusion. This leads to higher rates of surgical containment. Also the severity of Vitamin D deficiency might be an important determinant of the period of time required for ossification and healing. Vitamin D level is an important prognostic factor and must be measured in all patients with Perthes' disease. Prescribing Vitamin D supplements is advisable in this group of patients. However, the effects of these supplements on the course of the disease requires further research. Level of evidence: III

Aim. In an earlier study we identified severe Vitamin D deficiency as a problem in institutionalised children with cerebral palsy (CP), which resulted in rickets and a high incidence of fractures. The purpose of this study was to establish whether a cohort of non-ambulatory children with CP, living at home, presented with Vitamin D deficiency. Method. The participants were a consecutive sample (N=100) of non-ambulatory children with CP attending a CP outpatient clinic. Their ages ranged from 2 to 15 years (mean 5.8, SD 3.3 years). There were 57 males and 43 females. Nineteen were on Level IV of the Gross Motor Function Classification System (GMFCS), and 81 were on Level V. 66% were on anticonvulsant therapy (ACT). Basic demographic data was collected, and measurements included blood sample analysis and wrist radiographs. There was radiographic evidence of osteopenia and delayed ossification of the carpal bones. Results. Three participants had Vitamin D deficiency rickets confirmed by wrist changes and serology. There was a significantly higher level of Alkaline Phosphatase (p=0.04) in children on ACT than in those who did not receive ACT. Preliminary results show that one third of the children had Vitamin D deficiency. Conclusion. Non ambulatory children with CP are at risk of developing rickets. We recommend regular exposure to sunlight or Vitamin D supplementation as preventative measures. NO DISCLOSURES

Background. Vitamin D deficiency may increase predisposition to a number of paediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional paediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation and ethnicity. Methods. Individuals, age < 18 years, presenting to the regional paediatric orthopaedic service at Southampton, UK from 2008 to 2010 were investigated. Deprivation index scores were calculated from indices of deprivation. Results. 187 children (97 male, 90 female, mean age 7.1 years) underwent serum 25-(OH) D level measurement. 82% were white British and 11% of Asian ethnicity. The calculation of the total depravation index for the whole cohort showed 34 (18%) of subjects were in quartile 1 (least deprived), 54 (29%) in quartile 2, 49 (26%) in quartile 3 and 50 (27%) in quartile 4 (Most deprived). 60 (32%) had vitamin D insufficiency with 25-(OH) levels < 50nmol/l and 15 (8%) had vitamin D deficiency. No relation ship was identified between vitamin D level and social depravation score. Conclusions. There is a need for awareness of the prevalence of vitamin D deficiency in the paediatric orthopaedic population presenting with bone pain and lower limb deformity before commencing ‘observation or orthopaedic surgical treatment’

Aim. With the link between obesity and Slipped Upper Femoral Epiphysis (SUFE) well established and a rising number of paediatric orthopaedic patients presenting with vitamin D deficiency, the aim of our study was to establish the incidence of vitamin D deficiency in SUFE patients and whether low vitamin D levels increases the time to proximal femoral physeal fusion post surgical fixation. Method. All paediatric patients presenting to the orthopaedic department at University Hospital Southampton with a SUFE and tested for vitamin D between June 2007 to present day and who were subsequently found to have low levels of vitamin D, were eligible for inclusion in the study. A deficient level of vitamin D (25-(OH)D) was determined as < 52 nmols/L and insufficiency between 52–72 nmols/L. Levels > 72 nmols/L were considered to be normal. The normal time for 50% of physeal fusion on anteroposterior radiograph quoted in the literature is 9 months. Results. This study includes a cohort of 28 patients and 45 hips. All of these patients were treated with pinning insitu. Eighty six per cent were found to be vitamin D deficient. The mean physeal closure for these patients post fixation, including those yet to fuse and which have exceeded 12 months, was 23 months (range 9–64 months). Conclusion. This study has shown a correlation between vitamin D deficiency and prolonged physeal closure in SUFE patients. With an increasing prevalence of vitamin D deficiency, it is recommended that all patients presenting with a SUFE, be tested for low vitamin D levels, so that early treatment with supplementation can be initiated

Introduction. There has been a recent surge in the interest of the role of vitamin D in chronic musculoskeletal pain however there are limited studies that have investigated the link of vitamin D hypovitaminosis with low back pain. The aim of our study was to determine the prevalence of low vitamin D levels in patients who present with low back pain in an outpatient setting in the UK. Methods. Data was collected retrospectively from computerised databases of all patients who presented with low back pain from a single spinal consultant's outpatient clinic and have had serum levels of 25-hydroxycholecalciferol (25-OH vitamin D) requested. Data of these patients were collected from hospital electronic and paper records and analysed against their serum 25-OH vitamin D levels. Results. Data on 229 patients was collected over an 18 month period. 19.7% of patients presenting to the spinal outpatient clinics had severe 25-OH vitamin D deficiency (less than 15 nmol/L) compared to 2.6% of 3132 non-spinal outpatient clinic patients (p<0.001). However, the percentage of patients with deficient (15 to 30 nmol/L) but not severe deficiency was similar in both groups (37.6% versus 38.3%). There was no significant difference in the incidence of vitamin D deficiency whether a surgical or non-surgical pathology was present or not (p=0.62). Conclusion. We have found no link between vitamin D deficiency and low back pain in this study. Vitamin D deficiency is a common comorbidity in Leicester

Introduction: The presence of low levels of vitamin D in osteoarthritic patients has been reported as a substantial problem. We are not aware of any previous studies that have assessed the function of osteoarthritic patients undergoing joint replacement who are vitamin D deficient. This may be an important factor infiuencing preoperative function and postoperative outcome. The aim of this study was to investigate whether low vitamin D levels are associated with functional deterioration in patients with osteoarthritis of the hip undergoing total hip arthroplasty. Methods: We measured plasma 25-hydroxyvitamin D3 (25(OH)D3) levels in 62 consecutive Caucasian patients undergoing total hip arthroplasty for osteoarthritis. The patients were divided into two groups based on whether they were vitamin D sufficient or deficient. The groups were matched for age, gender and ASA grade. Results: The prevalence of vitamin D deficiency in our cohort of patients was comparable to recent population-based studies performed in the UK. Patients with vitamin D deficiency had lower preoperative Harris hip scores (Mann-Whitney test, p = 0.018) and were significantly less likely to attain an excellent outcome from total hip arthroplasty (Chi-square test, p = 0.038). Vitamin D levels were found to positively correlate with both preoperative and postoperative Harris hip scores. Discussion: Our results warrant further study of vitamin D deficiency in patients undergoing joint replacement as it is a risk factor for suboptimal outcome which is relatively simple and cheap to correct

Abstract. Introduction. Vitamin D deficiency in the UK is well documented − 30–40% of the population. It is an essential component of calcium metabolism and adequate levels are important for bone healing. Studies have demonstrated an overall prevalence of vitamin D deficiency/insufficiency at 77% in trauma patients aged >18, deficiency alone was 39%. Adequate vitamin D levels have a positive effect on bone mineral density and callus formation at fracture sites. Methods. We conducted a retrospective consecutive case series of all patients aged 0–50 undergoing surgical management for any fracture in October 2021 to March 2022. We assessed if vitamin D levels were checked and if patients were prescribed replacement as per local guidelines. Results. A total of 131 patients were identified, (mean 29 years; 83 male and 48 female). Most cases were upper limb fractures (n=78, 60%), as opposed to lower limb (n=53, 40%). Only 20 (15%) had their levels checked, of which 13 (65%) were insufficient/deficient (10 insufficiency, 2 deficiency, 1 severe deficiency). Of these 13 patients, only 3 (23%) were prescribed replacement therapy. Conclusions. Only a small proportion of patients had their levels checked, however the majority were insufficient/deficient. The prevalence in our study is consistent with larger epidemiology studies, which reflect a higher rate of deficiency in fracture patients compared to the general population. Thus, we propose that all patients in this age group should undergo a vitamin d level check upon time of clerking and this should be accurately treated as per trust guidance

Aims. This study investigated the effects of β-caryophyllene (BCP) on protecting bone from vitamin D deficiency in mice fed on a diet either lacking (D-) or containing (D+) vitamin D. Methods. A total of 40 female mice were assigned to four treatment groups (n = 10/group): D+ diet with propylene glycol control, D+ diet with BCP, D-deficient diet with control, and D-deficient diet with BCP. The D+ diet is a commercial basal diet, while the D-deficient diet contains 0.47% calcium, 0.3% phosphorus, and no vitamin D. All the mice were housed in conditions without ultraviolet light. Bone properties were evaluated by X-ray micro-CT. Serum levels of klotho were measured by enzyme-linked immunosorbent assay. Results. Under these conditions, the D-deficient diet enhanced the length of femur and tibia bones (p < 0.050), and increased bone volume (BV; p < 0.010) and trabecular bone volume fraction (BV/TV; p < 0.010) compared to D+ diet. With a diet containing BCP, the mice exhibited higher BV and bone mineral density (BMD; p < 0.050) than control group. The trabecular and cortical bone were also affected by vitamin D and BCP. In addition, inclusion of dietary BCP improved the serum concentrations of klotho (p < 0.050). In mice, klotho regulates the expression level of cannabinoid type 2 receptor (Cnr2) and fibroblast growth factor 23 (Fgf23) through CD300a. In humans, data suggest that klotho is connected to BMD. The expression of klotho is also associated with bone markers. Conclusion. These data indicate that BCP enhances the serum level of klotho, leading to improved bone properties and mineralization in an experimental mouse model. Cite this article: Bone Joint Res 2022;11(8):528–540

Aim. Assess the incidence of Vitamin D deficiency from a cohort of new referrals to a general Paediatric Orthopaedic outpatient clinic and evaluate the relationship between Vitamin D deficiency and the diagnosis of radiological or biochemical nutritional rickets. Methods. We performed a retrospective case note and biochemistry database review of all new patients seen in an elective Paediatric Orthopaedic clinic in the year 2010, who had Vitamin D levels measured. Radiographs were reviewed by the senior author to determine the presence or absence of radiological rickets. Biochemical rickets was diagnosed if there was deficient Vitamin D (< 20 mcg/ml) and raised PTH. Results. We identified 115 children with a mean age of 10.95 years (95% CI 10.24 to 11.68). There were 63 females, 52 males and 51 were of Asian ethnicity. The mean vitamin D level was 18.27mcg/ml (95% CI 16.13 to 20.41). One hundred and three patients (88%) were found to have sub-optimum vitamin D levels. Although, males and those of Asian origin were more likely to be deficient, this was not statistically significant. Winter/Springtime blood sampling was statistically more likely to show Vitamin D deficiency than in Summer/Autumn. Three Asian female children (2.61%) had radiological rickets. The association between low Vitamin D levels (< 20) and radiological or biochemical rickets had poor positive predictive values PPV. Conclusion. Suboptimal Vitamin D levels are common in children presenting with vague limb or back pain, suggesting ‘growing pains’ might reflect deficiency. Vitamin D levels cannot be used as a screening test for the diagnosis of radiological or biochemical ‘rickets’ due to its poor Positive Predictive Value. Further research into Vitamin D requirement is necessary, particularly in relation to growth and age, as growth is not linear and Vitamin D requirement is likely to vary accordingly

Aim:. Vitamin D deficiency is a common problem in the UK. It is more prevalent in patients with orthopaedic conditions. Previous studies in the literature have shown that vitamin D deficiency is associated with low patient-related outcome scores. To date, no studies have been performed in spinal patients. The aim of this study was to investigate whether there is a relationship between vitamin D status and pre-operative outcome scores in patients with AIS. Methods:. AIS patients undergoing scoliosis correction between July 2012 and May 2013 at the Royal National Orthopaedic Hospital were investigated. Serum 25-hydroxyvitamin D levels were measured and SRS-22r questionnaires were completed as part of their pre-admission work up. Results:. Twenty-five patients were enrolled into the study. Of these 11 patients (44%) had inadequate vitamin D levels. There was a significant correlation between the vitamin D level and SRS-22r scores (Spearman's 0.397, p=0.049; Pearson's 0.416, p=0.039). Discussion:. Vitamin D insufficiency is associated with worse pre-operative outcome scores in the AIS population. We are currently recruiting more patients into our study and also plan to look at the post-operative outcome scores to see if this difference is maintained. Conflict Of Interest Statement: No conflict of interest

Introduction. Osteonecrosis (ON) is a bone disease characterized by death of osteocytes and loss of associated hematopoietic elements usually occurring as focal lesions in weight bearing joints such as the hip. The pathophysiology of the disease is still unclear and osteonecrosis can be viewed as both a vascular and a bone disease. The number of mesenchymal stem cells (precursors of osteoblastic cells) has been shown to be depressed in patients with osteonecrosis. Also, the proliferation rate of the osteoblastic cells in the proximal femur may be depressed. These findings raised the possibility that osteonecrosis might be a disease of bone cells or bone metabolism. On this basis, we started this study to evaluate bone metabolism status among patients with osteonecrosis. Methods. In a prospective study, we evaluated 110 patients with osteonecrosis at the time of the diagnosis for vitamin D, parathormone, osteocalcin, and c-telopeptide measurements. DEXA was performed in all patients as well. We excluded from this study patients with sickle cell anemia (n=5), Gaucher disease (n=1), on hemodialysis (n=14), and who were already treated for osteoporosis (n=8). Results. There were 20 women and 90 men (mean age 47 ± 11 years). Twenty percent of the patients had unilateral osteonecrosis of the femoral head, 61 % of the patients had bilateral osteonecrosis, and 20 % had multifocal disease. Risk factors were corticosteroid and alcohol abuse. Vitamin D deficiency (<15 ng/ml) was found in 60 % of the patients and vitamin D insufficiency (15 to 30 ng/ml) was found in 15% of the patients. Secondary hyperparathyroidism (>55pg/ml) was present in only 7 patients. Patients with alcohol abuse had significantly lower vitamin D concentration than the other patients: 11.9 ± 8.7 vs. 20.8 ± 9.2 ng/ml (p=0.005). Among 90 samples, 45 showed an osteocalcin level below the normal range (<14 ng/ml). Most of the patients had a normal level of C-telopeptide. Patients with corticosteroid-associated osteonecrosis had significantly lower osteocalcin levels than others osteonecrotic patients: 14.1 ± 5.3 vs 22.7 ± 13.0 ng/ml (p=0.015). Bone mineral density measurements were obtained for 60 patients and showed a T-score < -1.5 at the lumbar site and < 1.8 at the hip. Conclusion. Patients with osteonecrosis have a high prevalence of vitamin D deficiency without secondary hyperparathyroidism. They also display a low bone turnover confirmed by low osteocalcin levels and normal levels of C-telopeptide. Osteonecrosis is also associated with severe osteopenia

To report the case of an asymptomatic simultaneous bilateral neck of femur fracture following vitamin D deficiency which was missed, misdiagnosed and treated for coexisting severe bilateral osteoarthritis knee. A male aged 62 years presented with severe osteoarthritis of both knee joints confining him to bed about eight weeks prior to presentation. The patient did not have any complaints pertaining to his hip joints/axial skeleton. Examination of the hip joints revealed only crepitus with absence of straight leg rising. Radiological survey showed bilateral displaced fracture neck of femur. He had elevated serum alkaline phosphatase; 119IU/L(N:39–117IU/L), decreased Serum 25 (OH) Vit D level;6.03ng/ml(N:7.6–75ng/ml), decreased spot urinary calcium;78mg/day(N:100–300mg/day) with normal serum calcium, phosphorus and highly raised parathormone levels;142.51pg/ml(N:12–72pg/ml). Tc-99 Bone scan showed increased radiotracer uptake in both the hip joints and knee joints. Bone Mineral Density was in favour of osteoporosis. Biopsy fromthe heads of both femurs also revealed osteoporosis. Bilateral staged total hip arthroplasty was done and he was put on Vitamin D replacement therapy. Patient was on regular monthly follow-up for intial one year and three monthly follow-up thereafter. At present with three year follow-up patient is community ambulant with a walking frame. Despite medical advice patient had denied total knee arthroplasty for osteoarthritis of his knee joints. Asymptomatic simultaneous bilateral neck of femur fracture is a rare injury and poses a diagnostic challenge to the treating orthopaedic surgeon with its bizarre clinical picture. Similar presentation of metabolic bone disease can be easily missed without a proper screening, keeping in mind a high index of suspicion for the above disorders. Besides proper clinical examination of both hip and knee joint should be performed in patients presenting with bilateral knee pain. A good functional outcome may be achieved with prompt surgical intervention and medical treatment

Aims. Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency. Methods. This multicentre retrospective observational study enrolled 122 female patients aged over 45 years with DRFs with extension deformity. DRF severity was assessed by three independent examiners using 3D CT. Moreover, it was categorized based on the AO classification, and the degree of articular and volar cortex comminution was evaluated. Articular comminution was defined as an articular fragment involving three or more fragments, and volar cortex comminution as a fracture in the volar cortex of the distal fragment. Serum 25-hydroxyvitamin-D level, bone metabolic markers, and bone mineral density (BMD) at the lumbar spine, hip, and wrist were evaluated six months after injury. According to DRF severity, serum 25-hydroxyvitamin-D level, parameters correlated with bone metabolism, and BMD was compared. Results. The articular comminuted group (n = 28) had a significantly lower median serum 25-hydroxyvitamin-D level than the non-comminuted group (n = 94; 13.4 ng/ml (interquartile range (IQR) 9.8 to 17.3) vs 16.2 ng/ml (IQR 12.5 to 20.4); p = 0.005). The AO classification and volar cortex comminution were not correlated with the serum 25-hydroxyvitamin-D level. Bone metabolic markers and BMD did not significantly differ in terms of DRF severities. Conclusion. Articular comminuted DRF, referred to as AO C3 fracture, is significantly associated with low serum 25-hydroxyvitamin-D levels. Therefore, vitamin D. 3. supplementation for vitamin D deficiency might prevent articular comminuted DRFs. Nevertheless, further studies must be conducted to validate the results of the current study. Cite this article: Bone Jt Open 2022;3(3):261–267

Introduction:. Blount's disease can be defined as idiopathic proximal tibial vara. Several etiologies including the mechanical theory have been described. Obesity is the only causative factor proven to be associated with Blount disease. Varus deformity is also a clinical feature of rickets and 31% of children with vitamin D deficiency rickets presented with varus deformities to the local Metabolic Bone clinics. The aim of this study is to assess if there is an association between vitamin D and Blount's disease. We hypothesize that children with Blount disease are more likely to be vitamin D deficient. Method:. This a retrospective study of pre-operative and post-operative patients with Blount's disease who were screened for vitamin D deficiency. Patients with known vitamin D deficiency and rickets were excluded. The study patients had the following blood tests: calcium, phosphate, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D. Body mass index (BMI) was also assessed. Results:. We recruited 50 patients. The mean age of these patients was 10.4 years (SD 3.88) with average BMI of 28.7 (SD 10.2). Fifty two % were overweight. Thirty (60%) patients were diagnosed with infantile, 16(32%) adolescent and 4(8%) juvenile Blount disease. Eight (16%) patients were found to be vitamin D depleted (less than 20 ng/ml). Of these eight patients, six had insufficient 25-hydroxyvitamin D levels (12–20 ng/ml) and while the other two were vitamin D deficient (less than 12 ng/ml). Conclusion:. Vitamin D deficiency is a public health problem worldwide. This study confirms that the prevalence of Vitamin D deficiency in children with Blount's disease is similar to healthy children and infants living in Johannesburg. There is no evidence that Vitamin D deficiency is a factor in causing Blount's disease. Routine screening for Vitamin D deficiency in children with Blount disease is not recommended

Purpose of study. We hypothesised that Vitamin D deficiency could be related to SUFE in children without endocrinological abnormalities. We therefore sought to examine prevalence and severity of Vitamin D insufficiency in a cross-section of SUFE patients. Methods. Vitamin D levels were tested for at time of hospital admission for operative treatment of SUFE. Seven patients, between the months of July 2011 to November 2011, presented to our institution. All were chronic, stable slips treated with in-situ screw fixation. All patients presented in the summer months and were operated on within 3 weeks of presentation. Results. 5/7 children were boys, age range (9–15yr). Symptoms had been present for 3–12 months prior to presentation, 5/7 patients had onset of symptoms during the winter and spring months – known to accord with lowest Vitamin D serum concentrations in population studies. All seven patients had low Vitamin D concentrations (<75nmol/L), and six patients had values that were considered insufficient (<50nmol/L). All patients were of dark-skinned ethnic origin but only one had a BMI of above 25kg/m. 2. (range 21–30). Conclusion. The true prevalence of vitamin D deficiency in the general population is not known although small studies suggest that it could be relatively common, particularly in children from ethnic minorities. Deficient levels (<25nmol/L) concord with increased risk of pathological fracture but associated risks of insufficient levels (25–50nmol/L) are unknown. SUFE is known to be more common in African-American, Polynesian and Aborigine children – as is vitamin D deficiency. We are raising the possibility that Vitamin D deficiency may be a relevant associated risk factor in SUFE

Introduction. Vitamin D deficiency is common in patients undergoing total hip (THA) or total knee arthroplasty (TKA) which may affect prosthesis survival and 90-day readmission rates. The purpose of this study was to assess whether preoperative Vitamin D deficiency or insufficiency have an influence on revision, readmission, and complication rates following THA and TKA. We hypothesized that low Vitamin D levels in patients undergoing THA and TKA have a negative effect on revision rates. Methods. Patients who underwent primary THA or TKA in a 2-year period university hospital were identified and stratified into 3 groups based on preoperative 25-hydroxyvitamin D serum levels: normal levels of 30 ng/ml or greater, (2) deficient levels of 20–29.9 ng/ml, and (3) insufficient levels of less than 20 ng/ml. Patient demographics and postoperative course were collected from the electronic medical record. Results. This study found that 45% out of 197 THA had Vitamin D levels less than 30ng/ml and significantly higher odds (14.1, p=0.018) of requiring revision surgery at a mean follow-up of 34 ± 11.2 months. Out of 167 TKA, 46% were Vitamin deficient/insufficient without an influence on revision rate. Vitamin D levels did not influence 90-day readmissions, wound complications, or reaching discharge goals. Low Vitamin D levels correlated with high BMI and young patient age for THA. Conclusion. Based on the findings of this study, the authors recommend preoperative Vitamin D3 supplementation (2,000–4,000 IU daily) for patients with a BMI greater than 30kg/m. 2. undergoing THA. Patient with Vitamin D deficiency may require referral for endocrinologic work-up. Based on the findings of this study, the authors have adopted postoperative Vitamin D3 supplementation with 2,000–4,000 IU daily for 3 months as part of the rehabilitation protocol for all patients undergoing THA

Introduction Vitamin D deficiency has been reported widely in various community groups but especially in the osteoporotic/fracture population. We decided to investigate the incidence in an elective female population undergoing hip or knee arthroplasty as this has not been previously reported. Methods Data was collected prospectively from a group of female patients who were undergoing hip or knee arthroplasty for osteoarthritis. Patients with rheumatoid or inflammatory arthritis were excluded, as were patients on Vitamin D supplements. Serum 25-hydroxyvitamin D (25 OHD) levels were measured as part of routine pre-operative work-up. A total of 40 female patients over a 12 month period were checked, with average age 66 years (range 15 to 93 years). Average height was 151 cm and weight 67 kg. Thirty total hips and 10 total knee replacements were performed. Vitamin D deficiency was classified as either marginal (25 OHD levels ranging from 25 to 50 nmol/L or frank (25 OHD levels, < 20–25 nmol/L). Results Eleven patients out of 40 (27.5%) had marginal deficiency and four of those patients (10%) had frank vitamin D deficiency. There was no correlation with height or weight or age. Conclusions This small study suggests that a significant percentage of patients undergoing elective lower limb arthroplasty for osteoarthritis have low Vitamin D levels