European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
Patients with vitamin D deficiency are more likely to develop complex region pain syndrome after extremity fractures: a large database propensity-matched cohort study.
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Berk Alexander, Good Logan, Burkhart Robert, Jawanda Harkirat, Florentino Samuel, Napora Josha
Аннотация
PURPOSE: The purpose of this study was to investigate the association between preexisting vitamin D deficiency and the development of complex regional pain syndrome (CRPS) in patients with isolated extremity fractures.
METHODS: The TriNetX database was queried to identify patients aged 18 and older who experienced upper or lower extremity fractures. Two cohorts were created based on the presence of vitamin D deficiency. Cohorts were propensity-matched based on age, gender, race, and ethnicity, and the incidence of CRPS following fracture compared.
RESULTS: A total of 2,891,380 patients met all inclusion criteria. Among these, 1,827,308 (63.2%) sustained an upper extremity fracture, while 1,064,072 (36.8%) sustained a lower extremity fracture. Vitamin D deficiency was observed in 152,023 patients (5.3%). After 1:1 propensity score matching, both cohorts included 151,591 patients (71,557 upper extremity, 80,034 lower extremity), with no significant differences in baseline characteristics. The incidence of CRPS was 0.24% for upper and 0.27% for lower extremity fractures. Patients with vitamin D deficiency had a higher risk of CRPS following both upper (OR 1.60, 95% CI 1.29-2.00; p < 0.001) and lower (OR 1.78, 95% CI 1.46-2.16; p < 0.001) extremity fractures. No association was found between preexisting vitamin D deficiency and CRPS after surgical intervention for either upper (OR 1.14, 95% CI 0.56-2.34; p = 0.715) or lower extremity fractures (OR 1.46, 95% CI 0.95-2.24; p > 0.084).
CONCLUSION: Vitamin D deficiency is independently associated with an increased risk of CRPS among patients sustaining upper and lower extremity fractures.
LEVEL OF EVIDENCE: Retrospective cohort study (prognosis); level of evidence, 3.
METHODS: The TriNetX database was queried to identify patients aged 18 and older who experienced upper or lower extremity fractures. Two cohorts were created based on the presence of vitamin D deficiency. Cohorts were propensity-matched based on age, gender, race, and ethnicity, and the incidence of CRPS following fracture compared.
RESULTS: A total of 2,891,380 patients met all inclusion criteria. Among these, 1,827,308 (63.2%) sustained an upper extremity fracture, while 1,064,072 (36.8%) sustained a lower extremity fracture. Vitamin D deficiency was observed in 152,023 patients (5.3%). After 1:1 propensity score matching, both cohorts included 151,591 patients (71,557 upper extremity, 80,034 lower extremity), with no significant differences in baseline characteristics. The incidence of CRPS was 0.24% for upper and 0.27% for lower extremity fractures. Patients with vitamin D deficiency had a higher risk of CRPS following both upper (OR 1.60, 95% CI 1.29-2.00; p < 0.001) and lower (OR 1.78, 95% CI 1.46-2.16; p < 0.001) extremity fractures. No association was found between preexisting vitamin D deficiency and CRPS after surgical intervention for either upper (OR 1.14, 95% CI 0.56-2.34; p = 0.715) or lower extremity fractures (OR 1.46, 95% CI 0.95-2.24; p > 0.084).
CONCLUSION: Vitamin D deficiency is independently associated with an increased risk of CRPS among patients sustaining upper and lower extremity fractures.
LEVEL OF EVIDENCE: Retrospective cohort study (prognosis); level of evidence, 3.