Patients with vitamin D deficiency are more likely to develop complex region pain syndrome after extremity fractures: a large database propensity-matched cohort study
Abstract
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 0.084).
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.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,891,380 participants or records.
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