Elsevier

Archives of Gerontology and Geriatrics

Volume 49, Issue 3, November–December 2009, Pages 364-367
Archives of Gerontology and Geriatrics

Low patient compliance—A major negative factor in achieving vitamin D adequacy in elderly hip fracture patients supplemented with 800 IU of vitamin D3 daily

https://doi.org/10.1016/j.archger.2008.12.001Get rights and content

Abstract

Achievement of adequate vitamin D3 level is crucial for the treatment of hip fracture patients. Currently used vitamin D3 supplementation in Israel ranges between 200 and 800 IU/day. The study objectives were to evaluate the effects of 800 IU/day vitamin D3 and 1.200 mg of calcium carbonate supplementation to achieve adequate vitamin D3 level of 30 ng/ml in elderly hip fracture patients. One hundred and twenty-two elderly patients after surgical hip fracture correction aged 73.0 ± 9.5, who were enrolled in a post-surgical treatment program (PSTP). The patients received 800 IU of vitamin D3 and 1.200 mg of calcium carbonate daily. Serum 25(OH)D and plasma PTH levels were assessed during initial hospital stay and at quarterly follow-up visits for 2 years. At baseline, 120 patients (98.4%) had 25(OH)D serum level <30 ng/ml. Forty-two patients (34.4%) had 25(OH)D serum level <10 ng/ml and these were considered as vitamin D3 deficient. After 3 months, 29 patients (23.8%) were fully adherent to the supplement, 32 were (26.2%) partially adherent. The dropout rate at 1 year was 55.7%. The major reason for the discontinuation of participation was non-compliance. We conclude that the majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. Compliance with calcium and vitamin D3 supplements was extremely low. An adequate vitamin D status was not achieved with daily vitamin D3 supplementation of 800 IU. Supplementation strategies using a periodic single high dose of vitamin D3 might be more appropriate and should be considered in these patients.

Introduction

Hip fracture rate increases yearly by 1–3% in developed countries (Cummings and Melton, 2002). The number of hip fractures worldwide was 1.7 million in 1990; it is predicted to reach 6.3 million by 2050 (Cooper et al., 1992). The number of hip fractures in Israel is currently 6000 per year (Givon, 1999). The risk of a second hip fracture could reach 20% in the course of an individual's life (Dolk, 1989). Improvement of vitamin D3 status has been reported to decrease hip fracture risk by 30% (Chapuy and Meunier, 1996).

According to the recent consensus (Dawson-Hughes et al., 2005) about the role of vitamin D3 in the prevention of hip fractures in the elderly, the suggested target serum 25(OH)D concentration was >30 ng/ml (75 nmol/l). Currently used vitamin D3 supplementation in Israel ranges between 200 and 800 IU/day. The positive role of UV irradiation in vitamin D3 synthesis vs. the dangers of sun exposure, underlines the complexity of supplying vitamin D3, and the importance of a safe and reliable source for vitamin D3 supplementation (Wolpowitz and Gilchrest, 2006). Furthermore, antiresorptive treatment with bisphosphonates should be given to vitamin D3 replenished patients.

The aim of this work was to assess the effect of 800 IU/day vitamin D3 supplementation on vitamin D status and plasma PTH in elderly participants of a PSTP; to assess whether this treatment can ensure vitamin D adequacy and how soon it could be achieved, and to assess long-term adherence to this treatment regimen.

Section snippets

Subjects

Participation in the PSTP was offered to all elderly hip fracture patients aged 50–90 years, who underwent surgical correction of hip fracture in the Department of Orthopedic Surgery during 2004. Frequent fallers, patients having major psychiatric problems, malnutrition or active malignant disease in the last 5 years and patients receiving bisphosphonates for established osteoporosis were excluded. Written informed consent was obtained from all participants. The study was approved by the

Results

At baseline, mean 25(OH)D concentration was 15.14 ± 18.58 ng/ml, range 2.4–20.7; 120 patients (98.3%) had 25(OH)D serum level <30 ng/ml; and 42 (34.4%) were vitamin D3 deficient with serum 25(OH)D <10 ng/ml (Fig. 1). Patients with the lowest 25(OH)D level had the highest serum PTH, p = 0.042; 42 patients (34.4%) with 25(OH)D < 10 ng/ml, mean PTH 49.1 ± 22.7 pmol/l; 33 patients (27.1%) with 25(OH)D 10–15 ng/ml, mean PTH 37.8 ± 22.9; 45 (36.9%) with 25(OH)D 15–29.9 ng/ml, mean PTH 35.4 ± 15.8 pmol/l. In two patients

Discussion

Vitamin D3 synthesis in the skin under the influence of UV light decreases with aging due to insufficient sunlight exposure and decreased functional capacity of the skin (Lips, 2001, Wolpowitz and Gilchrest, 2006). According to the current recommendation, adequate intake of vitamin D3 is 400 IU daily for people 51–70 years old and 600 IU for 71 years and older (Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, 1997).

Vitamin D3 deficiency appears to be a widespread, but

Conclusion

The majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. During participation in the PSTP, partial adherence to prescribed calcium and vitamin D3 supplements was achieved. Participation in the specially designed outpatient clinic program improved the rate of actively treated patients and led to an improvement in vitamin D status (Segal et al., 2005), but the dropout rate from the daily supplement regimen was high. The majority of elderly hip fracture patients had not

Conflict of interest statement

This study was sponsored by MSD Pharmaceutical, Israel (an investigator's initiative grant). The sponsor took part in the study design and data analysis. Sophia Ish-Shalom has received funds for research, fees for consulting, or both from Lilly, MSD, Transpharma, CTS, Aventis, Genmedics and Novartis. None of the other authors had a personal or financial conflict of interest.

Acknowledgements

The results were partially presented at the 6th ISNAO (International Symposium on Nutritional Aspects of Osteoporosis) 2006 Meeting in Lausanne, Switzerland, May, 2006, and published in the ISNAO 2006 Proceedings edited by Burckhardt P., Heaney, R. and Dawson-Hughes, P.

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