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Vitamin D hypovitaminosis and efficacy of supplementation in spine surgery patients

Lindley, Emily M., PhDa; Perry, James, DOb; Patel, Manishi, MBBSa; Noshchenko, Andriy, PhDa; Bond, Amy, RN, BSNa; Burger, Evalina L., MDa; Cain, Christopher M.J., MDa; Patel, Vikas V., MA, MDa

doi: 10.1097/BCO.0000000000000741
Original Research

Background: Although there is evidence that hypovitaminosis D is present in many otherwise healthy adults, there is little information on supplementation in patients undergoing spine surgery. Thus, the purpose of this study was to determine the prevalence of preoperative hypovitaminosis D in spine surgery patients and evaluate the efficacy of postoperative vitamin D supplement regimens.

Methods: Per standard of care, serum 25-hydroxyvitamin D levels were regularly drawn preoperatively and at 6 mo postoperatively; patients with hypovitaminosis D were prescribed a 3-month supplementation regimen based on their level of deficiency: 2000 IU/day, 50,000 IU/wk, or both 50,000 IU/wk and 2000 IU/day. For this analysis, we retrospectively reviewed charts of patients who had spine surgery to identify those with preoperative vitamin D levels. Rates of hypovitaminosis D were compared before and after treatment with supplementation.

Results: Of 853 patients with preoperative serum vitamin D levels, 505 (59.2%) had hypovitaminosis D (<30 ng/mL). The rate of insufficiency (20-29 ng/mL) was 31.5%, and the rate of deficiency was 27.7%. At 6 mo postoperatively, the mean serum vitamin D level of patients with hypovitaminosis D increased from 19.7 ng/mL to 30.0 ng/mL (P<0.001). However, only 42.6% of patients achieved sufficiency at 6 mo. There were no differences in improvements between the supplementation regimens.

Conclusions: Hypovitaminosis D is common among patients undergoing spine surgery. Patients should be tested preoperatively and prescribed a supplementation for at least 3 mo postoperatively. Serum levels should be checked regularly postoperatively, especially in deficient patients, to determine if further treatment is needed.

aDepartment of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO

bJacksonville Orthopaedic Institute, Jacksonville, FL

Financial Disclosure: The following authors disclose a financial relationship outside this work: Dr. Lindley with United Health and Medtronic; Dr. Burger with Medtronic, Anstutz, Aesculap, SI Bone, Vertiflex, Medicrea, Orthofix, Integra, Pfizer, Spinal Kinetics, and Mainstay; Dr. Patel with Pfizer, Orthofix, Zimmer, Biomet, Medtronic, Aesculap, Medicrea, Globus, Premia, SI Bone, Mainsta, and Springer. The other authors have no disclosures. The authors report no further conflicts of interest.

Correspondence to Emily M. Lindley, PhD, University of Colorado Anschutz Medical Campus, Department of Orthopedics, Mail Stop F432, Aurora, CO 80045 Tel: +303-724-0239; fax: +303-724-0919; e-mail:

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