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

Arch Phys Med Rehabil. 2011 May;92(5):705-11.
Pellicane AJ, Wysocki NM, Mallinson TR, Schnitzer TJ.
Wayne State University, Rehabilitation Institute of Michigan, Detroit, MI.

OBJECTIVES: To assess the prevalence of 25-hydroxyvitamin D (25OHD) 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.

Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21530717
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See also Vitamin D Life

• All items in Category Bone 81 items as of Aug 2011
• All items in category Bone - Osteoporosis 83 items Aug 2011
• Vitamin D and Fracture Prevention – June 2010 file
• Vitamin D and calcium for the prevention of fractures
• Injury-Prevention with Vitamin D – Feb 2010
• Overview Osteoporosis and vitamin D
• Overview: Vitamin D and falling
• Overview: Bone fractures and vitamin D
• Lowest cost osteoporosis treatment in China was vitamin D and Calcium – Oct 2010
• Evidence-based Review of Vitamin D -2010 Osteoporosis Grade = B
• Cochrane review finds that Vitamin D helps treat Osteoporosis – Feb 2010
• 2000 to 3000 IU required to start to help with Osteoporosis – June 2010
• Do not just take more Calcium if you fear Osteoporosis- Mercola Dec 2010 from book: The Calcium Lie
• Overview of Magnesium
• Fewer falls and fractures as vitamin D is increased – 1800 to 4000 IU July 2010 2 abstracts with chart
• 4000 IU Vitamin D intervention helped elderly bones – March 2010
• Is it ethical to not give vitamin D in osteoporosis trials– NEJM Sept 2010
• National Osteoporosis Foundation on Vitamin D - more than 30 ng - 2010
• Osteoporosis medicines - several include vitamin D from National Osteoporosis Foundation
• Vitamin D recommendations by Osteoporosis Canada - Sept 2010 800-2000 IU daily, 10,000 IU is probably safe
• Review of vitamin D pathways to bone health - July 2010 with many summaries of vitamin D INTERVENTIONS
• Low Calcium and vitamin D makes osteomalacia but either makes osteoporosis – Sept 2010
• Prefer more than 30 ng of Vitamin D and 700 mg Calcium for Osteoporosis – Mar 2011
• Wrist fracture is also associated with vitamin D inadequacy – Feb 2011
• Half of orthopedic surgeries had vitamin D less than 32 ng – Dec 2010
• Noticed bones heal faster when more than 60 ng of vitamin D
• Low vitamin D before orthopedic surgery – dark skin 5X more likely – Oct 2010
  suspect not just dark skin, but those also at risk of being low on vitamin D: sunlight, elderly, medical problems, etc.
• Hip surgery followed by 100,000 IU, then 1,000 IU of vitamin D daily – June 2010
• Upper body bones fractured along with hip when extremely low on vitamin D – Sept 2010
• Vitamin D and Fracture Prevention – June 2010 file
• Vitamin D and Calcium for the prevention of fractures
• Cochrane review finds that Vitamin D helps prevent fractures– downloaded Feb 2010
• Osteoporosis reduced by 800 or more IU of vitamin D - July 2010
• 890 IU of vitamin D and 1200 mg Calcium improved bone density – July 2010
• Both Calcium AND vitamin D needed to prevent elderly fractures – Sept 2010
• Calcium and just 900 IU of vitamin D can improve Bone Density – July 2010
• 400 IU of Vitamin D Magnesium and Calcium helped Twin bones – Feb 2011
  • 400 IU is the least amount of vitamin D - wonder how low of vitamin D needed if take all of the co-factors
• Hip fractures in India - editorial with recommendation Sept 2010
• 75 % of hip fractures associated with vitamin D deficiency - Jan 2011
• Low vitamin D may account for half of the reasons for osteomalacia – Oct 2010
• Fewer falls and fractures as vitamin D is increased – 1800 to 4000 IU July 2010
• 4X more likely to add Calcium to diet than take supplements – Sept 2010
• Calcium and Vit D reduce fractures but increase kidney stones - 2006 when take 2000 mg Calcium
• Calcium level somewhat higher due to vitamin D might be a problem – June 2010
• Vitamin D and Calcium Absorption – Sept 2010
• Calcium citrate and more than 800 IU of vitamin D to treat Osteoporosis – Mar 2011
• 1800 to 4000 IU vitamin D to get 30 to-44 ng no risk osteo - July 2010.pdf file
• Cadavers with good skeletons had 30 ng of vitamin D – Feb 2010
• Should orthopaedic surgeons prevent future fractures with vitamin D etc – June 2011
• Wrist fracture is also associated with vitamin D inadequacy – Feb 2011
• National Osteoporosis Foundation on Vitamin D - more than 30 ng - 2010 800 to 1000 IU daily for elderly
• Lowest cost osteoporosis treatment was vitamin D and Calcium – Oct 2010
• Half of orthopedic surgeries had vitamin D less than 32 ng – Dec 2010
• Noticed bones heal faster when more than 60 ng of vitamin D
  • suspect not just dark skin, but those also at risk of being low on vitamin D: sunlight, elderly, medical problems, etc.
• Hip surgery followed by 100,000 IU, then 1,000 IU of vitamin D daily – June 2010
• 3 instead of 11 fractures with Parkinson disease when have enough sun - Nov 2010 sun or UV works as well or better than vitamin D supplements
• Upper body bones fractured along with hip when extremely low on vitamin D – Sept 2010
• Low cost co-factors for vitamin D More than Calcium is needed for healthy bones
• Vitamin D and Fracture Prevention – June 2010
• Vitamin D and calcium for the prevention of fractures
• Cochrane review finds that Vitamin D helps prevent fractures– downloaded Feb 2010
• Osteoporosis reduced by 800 or more IU of vitamin D - July 2010
• 4000 IU Vitamin D intervention helped elderly bones – March 2010
• 400 IU of Vitamin D Magnesium and Calcium helped Twin bones – Feb 2011
  • 400 IU is the least amount of vitamin D - wonder how low of vitamin D needed if take all of the co-factors
• Hip fractures in India - editorial with recommendation Sept 2010
• 75 percent of hip fractures associated with vitamin D deficiency - Jan 2011
• 30 percent less chance of dying after hip fracture if take vitamin D and other drugs – 2011
• Hip fractures worse if very low on vitamin D – Mar 2011
• Fracture patients with bone diseases lacked vitamin D and calcium – Mar 2011
• Hip fracture patients had only 16 ng of vitamin D – May 2011
  Spine fracture patients had somewhat more: 18 ng
• Majority of animal bone fractures healed more quickly with vitamin D – May 2011
• Many abstracts on fewer stress and bone fractures with vitamin D