Vitamin D3 Levels in Adults Attending Elective Orthopaedic Surgery Clinics at Kenyatta National Hospital

Abstract

Elective orthopedic surgery (EOS) encompasses procedures like ligament reconstruction, joint replacement, and fracture fixation, often needed to alleviate persistent pain and disability and enhance quality of life. Conditions such as osteoarthritis, bone tumors, fractures, and back pain are managed through EOS outpatient clinics. Vitamin D is crucial for the musculoskeletal system, aiding in bone metabolism and soft tissue healing by maintaining calcium and phosphate balance. EOS patients frequently have lower vitamin D3 levels due to factors like disease duration, specific conditions, old age, high BMI, reduced mobility, limited sunlight exposure, alcohol and tobacco use, and certain religious practices like wearing a Hijab. Measuring serum 25(OH) vitamin D provides a reliable assessment of vitamin D status. More research is necessary to understand the impact of vitamin D on bone healing in EOS patients. Study Objective: The purpose of this study is to determine the levels of vitamin D3 in patients attending EOS clinics at Kenyatta National Hospital. Methods: A cross-sectional study was conducted involving 97 patients from orthopedic clinics. Data were collected through structured interviews and clinical assessments, focusing on demographic variables, lifestyle factors, comorbidities, and Vitamin D3 levels. The Vitamin D3 status was categorized into deficient (<20 ng/mL), insufficient (21-29 ng/mL), and normal (30-50 ng/mL) based on serum 25-hydroxyvitamin D3 concentrations. SPSS version 28 was used for analysis. Results: The findings revealed that there was a significant proportion of the patients who had Vitamin D3 deficiency, 10.3% had a deficit and 33% had insufficient levels. Age was significantly associated with Vitamin D3 levels, with patients over 36 years exhibiting higher deficiency rates (p=0.000). Urban residency was linked to higher deficiency rates, attributed to limited sunlight exposure. Educational attainment correlated with Vitamin D3 status, with those having only secondary education showing higher insufficiency rates (p=0.014). Lifestyle factors such as smoking and alcohol consumption were significantly associated with lower Vitamin D3 levels (p=0.000 for both). Body Mass Index (BMI) was a crucial determinant, with higher BMI linked to greater deficiency (p=0.000). Sunlight exposure was vital, with less than 30 minutes per day correlating with higher deficiency rates (p=0.011). Conclusion and recommendations: The study identified several factors influencing Vitamin D3 levels among orthopedic patients, including age, education level, lifestyle habits, BMI,

sunlight exposure, and immobility. These findings underscore the need for targeted interventions to address Vitamin D3 deficiency, particularly for older adults, , individuals with lower education, smokers, alcohol consumers, overweight patients, and those with limited sunlight exposure. Strategies such as increased sun exposure, dietary modifications, supplementation, and lifestyle changes could effectively improve Vitamin D3 levels and enhance patient outcomes