When it comes to speeding up post-operative healing following orthopedic surgery, people seek out treatments ranging from platelet rich plasma therapy to deer antler extract.
But what about vitamin D? It is associated with improving bone density, immune response and muscle functions. Yet it hasn't it been studied as a supplement to aid in both the prevention and recovery of injury.
Dr. Mike Angeline, an orthopedic surgeon practicing with the Mercy Health System in Janesville, Wis., notes that few researchers are considering this simple solution. He's one of the few.
As for platelet rich plasma therapy, the process involves drawing blood from a patient, then extracting a high concentration of platelets to promote healing and injecting the serum back into the site of the injury. Orthopedic specialists are divided on the efficacy. Deer antler extract is a supplement that may contain IGF-1, an insulin-like growth factor that is banned by the National Football League.
Vitamin D is a simple, low-cost alternative. Angeline recently conducted a study to see whether vitamin D deficiency in rats would negatively impact healing and the strength of the tendon-to-bone interface following rotator cuff surgery. His findings suggested that low levels of vitamin D may affect the body's ability to recover immediately after surgery.
Angeline presents his findings Thursday in Chicago at the annual meeting of the American Academy of Orthopaedic Surgeons.
Q: Why do you think there hasn't been much attention on the effects of vitamin D as a means of recovering from orthopedic surgery?
A: We know in the general population, it's totally under-recognized with more than a billion people worldwide who are vitamin D deficient. There are no specific studies that look at its influence on the healing of the rotator cuff. A lot of the research for rotator cuff repair focuses on platelet rich plasma, or PRP, which is sort of the hot topic, or stem cells. Vitamin D may or may not improve their healing or improve their outcome after surgery and that's what we're trying to figure out. There's just not that much of a focus on [hormones and vitamins] because, to tell the truth, to pharmaceutical companies, vitamin D is pretty generic so they won't make that much money on it.
Q: One billion people could be vitamin D deficient? Why so many when exposure to the sun delivers vitamin D?
A: I think it's diet. I think it's when we exercise: winter vs. summer, outdoors vs. indoors, where you're living, if you're in the northern latitudes in the northern U.S. I think we don't recognize when we're deficient. You or I may actually be deficient but we don't do anything about it. It could also be determined by ethnicity, where darker individuals who have higher skin pigmentation don't synthesize enough vitamin D based on the skin's ability to absorb the sunlight.
Q: How do you determine a deficient level of vitamin D in rats?
A: We don't know what a deficient level is for rats. What we did is a pilot study before undertaking our main study. We had rats on a deficient diet for about eight months. We took measurements at different time periods. The goal of that was to figure out how long it would take to get a significant reduction in vitamin D. We figured at about six weeks, it doesn't drop significantly after that. At six weeks and four months, the values were pretty much the same. But then at eight months, it drops by about half again.
Q: Are you doing any follow-up trials?
A: In New York, we're doing a clinical study looking at what the vitamin D levels are for sports injuries and whether it has an effect on the healing after rotator cuff repairs. We took a look at the New York Giants. The study's not published yet, but we followed individuals that were injured and those injured individuals had decreased vitamin D levels.
Q: Do you personally see a lot of promise in using vitamin D as a pre- and post-operative treatment?
A: It's a low-cost, high-benefit potential intervention. As long as the patient is taking vitamin D, you could potentially change whether they're deficient and hopefully improve their outcome. I think it has positive benefits on healing, improved strength, and improved tendon integrity after repair. It's something I've considered [giving to patients]. The only thing is the cost to the insurance company. That's the real question. I take it myself. Honestly, I don't think there's a downside to taking it. There's no risk. You can't get enough of vitamins. It's pretty low-cost. Could it help you tremendously? Maybe not, but it can't hurt to try.