{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:31:14Z","timestamp":1778171474165,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Arthrosehilfe e.V.","award":["P557-A284_Horas\/Heinz\/Rudert"],"award-info":[{"award-number":["P557-A284_Horas\/Heinz\/Rudert"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31\/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19\/31) of those had sufficient vitamin D levels, while 38.7% (12\/31) had insufficient and further 6% (2\/31) deficient vitamin D levels (&lt;20 ng\/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49\/77) were vitamin D deficient, 23.4% (18\/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng\/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng\/mL for vitamin D substitution vs. 18.4 ng\/mL for no substitution; p &lt; 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care.<\/jats:p>","DOI":"10.3390\/nu17162635","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:16:37Z","timestamp":1755184597000},"page":"2635","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["High Prevalence of Vitamin D Deficiency in Patients Undergoing Total Shoulder or Elbow Arthroplasty"],"prefix":"10.3390","volume":"17","author":[{"given":"Miledi","family":"Hoxha","sequence":"first","affiliation":[{"name":"Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tizian","family":"Heinz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6594","authenticated-orcid":false,"given":"Maximilian","family":"Rudert","sequence":"additional","affiliation":[{"name":"Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany"},{"name":"Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9965-1799","authenticated-orcid":false,"given":"Kilian","family":"List","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Achenbach","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerrit","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, 26129 Oldenburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Wei\u00dfenberger","sequence":"additional","affiliation":[{"name":"Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany"},{"name":"Orthopaedic Surgery Centre (OCW), 97070 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9086-3541","authenticated-orcid":false,"given":"Konstantin","family":"Horas","sequence":"additional","affiliation":[{"name":"Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany"},{"name":"Frankfurt Centre for Bone Health and Endocrinology, 60313 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.5435\/00124635-201006000-00010","article-title":"Treatment of glenohumeral osteoarthritis","volume":"18","author":"Izquierdo","year":"2010","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.jse.2010.02.009","article-title":"Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015","volume":"19","author":"Day","year":"2010","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Harjula, J.N.E., Paloneva, J., Haapakoski, J., Kukkonen, J., and \u00c4\u00e4rimaa, V. (2018). Increasing incidence of primary shoulder arthroplasty in Finland\u2014A nationwide registry study. BMC Musculoskelet. Disord., 19.","DOI":"10.1186\/s12891-018-2150-3"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Longo, U.G., Papalia, R., Castagna, A., De Salvatore, S., Guerra, E., Piergentili, I., and Denaro, V. (2022). Shoulder replacement: An epidemiological nationwide study from 2009 to 2019. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05849-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1016\/j.jse.2020.03.049","article-title":"The incidence of shoulder arthroplasty: Rise and future projections compared with hip and knee arthroplasty","volume":"29","author":"Wagner","year":"2020","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1302\/0301-620X.89B10.19038","article-title":"Does bone quality predict loosening of cemented total hip replacements?","volume":"89","author":"Nixon","year":"2007","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1302\/2046-3758.31.2000218","article-title":"Baseline bone mineral density and boneturnover in pre-operative hip and knee arthroplasty patients","volume":"3","author":"James","year":"2014","journal-title":"Bone Jt. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.injury.2007.02.049","article-title":"Risk factors for periprosthetic femoral fracture","volume":"38","author":"Franklin","year":"2007","journal-title":"Injury"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/1758573220906520","article-title":"Vitamin D deficiency and total shoulder arthroplasty complications","volume":"13","author":"Smith","year":"2021","journal-title":"Shoulder Elb."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"942","DOI":"10.21037\/atm-21-779","article-title":"The role of vitamin D and vitamin D deficiency in orthopaedics and traumatology-a narrative overview of the literature","volume":"9","author":"Maier","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wintermeyer, E., Ihle, C., Ehnert, S., St\u00f6ckle, U., Ochs, G., de Zwart, P., Flesch, I., Bahrs, C., and Nussler, A.K. (2016). Crucial Role of Vitamin D in the Musculoskeletal System. Nutrients, 8.","DOI":"10.3390\/nu8060319"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.beem.2011.05.002","article-title":"The effect of vitamin D on bone and osteoporosis","volume":"25","author":"Lips","year":"2011","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"594","DOI":"10.4081\/jphr.2015.594","article-title":"Vitamin D Status, Bone Mineral Density and Mental Health in Young Australian Women: The Safe-D Study","volume":"4","author":"Callegari","year":"2015","journal-title":"J. Public Health Res."},{"key":"ref_14","first-page":"118","article-title":"Vitamin D: The \u201csunshine\u201d vitamin","volume":"3","author":"Nair","year":"2012","journal-title":"J. Pharmacol. Pharmacother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.3928\/01477447-20180424-04","article-title":"Preoperative Vitamin D Deficiency Is Associated with Higher Postoperative Complication Rates in Total Knee Arthroplasty","volume":"41","author":"Hegde","year":"2018","journal-title":"Orthopedics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e23.00150","DOI":"10.2106\/JBJS.RVW.23.00150","article-title":"Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis","volume":"12","author":"Vivek","year":"2024","journal-title":"JBJS Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","first-page":"587","article-title":"Vitamin D deficiency in orthopaedic patients: A single center analysis","volume":"79","author":"Maier","year":"2013","journal-title":"Acta Orthop. Belg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.2106\/JBJS.I.01231","article-title":"Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery: A single-center analysis","volume":"92","author":"Bogunovic","year":"2010","journal-title":"J. Bone Jt. Surg. Am. Vol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jor.2020.03.010","article-title":"Hypovitaminosis D in lower extremity Joint Arthroplasty: A systematic review and meta-analysis","volume":"21","author":"Emara","year":"2020","journal-title":"J. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"321","DOI":"10.21037\/atm.2018.08.21","article-title":"High prevalence and seasonal variation of hypovitaminosis D in patients scheduled for lower extremity total joint arthroplasty","volume":"6","author":"Piuzzi","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e651","DOI":"10.3928\/01477447-20160606-04","article-title":"Hypovitaminosis D in Patients Undergoing Shoulder Arthroplasty: A Single-Center Analysis","volume":"39","author":"Inkrott","year":"2016","journal-title":"Orthopedics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1053\/j.sart.2023.10.003","article-title":"The effect of vitamin D insufficiency on outcomes and complication rates after shoulder arthroplasty: A single center retrospective examination","volume":"34","author":"MacConnell","year":"2024","journal-title":"Semin. Arthroplast. JSES"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1210\/er.2012-1012","article-title":"The Roles of Vitamin D in Skeletal Muscle: Form, Function, and Metabolism","volume":"34","author":"Girgis","year":"2013","journal-title":"Endocr. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s10195-016-0414-y","article-title":"Is there an association between low serum 25-OH-D levels and the length of hospital stay in orthopaedic patients after arthroplasty?","volume":"17","author":"Maier","year":"2016","journal-title":"J. Orthop. Traumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S151","DOI":"10.1016\/j.arth.2024.05.012","article-title":"Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications After Primary Total Joint Arthroplasty","volume":"39","author":"Birinci","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.arth.2020.08.003","article-title":"The Association of Calcium and Vitamin D Use with Implant Survival of Total Knee Arthroplasty: A Nationwide Population-Based Cohort Study","volume":"36","author":"Kong","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"336","DOI":"10.4055\/cios20147","article-title":"Vitamin D Trajectory after Total Knee Arthroplasty: A Method for Quick Correction in Deficient Patients","volume":"13","author":"Maniar","year":"2021","journal-title":"Clin. Orthop. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1016\/j.arth.2022.08.020","article-title":"Vitamin D(3) Supplementation Prior to Total Knee Arthroplasty: A Randomized Controlled Trial","volume":"38","author":"Weintraub","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Horas, K., Hoxha, M., Heinz, T., Jakuscheit, A., List, K., Maier, G.S., Wei\u00dfenberger, M., and Rudert, M. (2024). Prevalence and Risk Factors of Vitamin D Deficiency in Patients Scheduled to Undergo Revision Arthroplasty of the Hip, Knee and Shoulder-Data from a Single-Centre Analysis. Nutrients, 16.","DOI":"10.3390\/nu16183060"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/MED.0000000000000371","article-title":"Vitamin D in obesity","volume":"24","author":"Walsh","year":"2017","journal-title":"Curr. Opin. Endocrinol. Diabetes"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I., and Mili\u0107, S. (2019). Vitamin D Deficiency: Consequence or Cause of Obesity?. Medicina, 55.","DOI":"10.3390\/medicina55090541"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5820","DOI":"10.1002\/fsn3.2488","article-title":"Smoking behavior and circulating vitamin D levels in adults: A meta-analysis","volume":"9","author":"Yang","year":"2021","journal-title":"Food Sci. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1007\/s12020-015-0548-3","article-title":"Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort","volume":"49","author":"Klingberg","year":"2015","journal-title":"Endocrine"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/16\/2635\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:31Z","timestamp":1760034451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/16\/2635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":34,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["nu17162635"],"URL":"https:\/\/doi.org\/10.3390\/nu17162635","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}