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Before and after hip fracture, vitamin D deficiency may not be treated sufficiently

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Abstract

Summary

Our findings show that only about 20 % of seniors receive vitamin D supplementation prior to their index hip fracture or after the event. We further confirm the high prevalence of severe vitamin D deficiency in this population and show that those who receive supplementation have significantly higher 25-hydroxyvitamin D (25(OH)D) status.

Introduction

The aim of this study is to assess current practice in pre- and post-hip fracture care practice with respect to vitamin D supplementation.

Methods

We surveyed 1,090 acute hip fracture patients age 65 and older admitted to acute care for hip fracture repair; 844 had serum 25-hydroxyvitamin D levels measured upon admission to acute care, and 362 agreed to be followed at 12 month after their hip fracture. Prevalence of vitamin D supplementation was assessed upon admission to acute care (at the time of hip fracture), upon discharge from acute care, and at 6 and 12 months follow-up.

Results

Of 1,090 acute hip fracture patients (mean age 85 years, 78 % women, 59 % community-dwelling), 19 % had received any dose of vitamin D prior to the index hip fracture, 27 % (of 854 assessed) at discharge from acute care, 22 % (of 321 assessed) at 6 month, and 21 % (of 285 assessed) at 12 month after their hip fracture. At the time of fracture, 45 % had 25(OH)D levels below 10 ng/ml, 81 % had levels below 20 ng/ml, and 96 % had levels below 30 ng/ml. Notably, 25(OH)D levels did not differ by season or gender but were significantly higher among 164 hip fracture patients, with any vitamin D supplementation compared with 680 without supplementation (19.9 versus 10.8 ng/ml; p < 0.0001).

Conclusion

Only about 20 % of seniors receive vitamin D at the time of their fracture and after the event. This is despite the documented 81 % prevalence of vitamin D deficiency. Interdisciplinary efforts may be warranted to improve vitamin D supplementation in seniors both before a hip fracture occurs and after.

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References

  1. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208

    PubMed  CAS  Google Scholar 

  2. Bischoff-Ferrari HA, Orav JE, Barrett JA, Baron JA (Sep 2007) Effect of seasonality and weather on fracture risk in individuals 65 years and older. Osteoporos Int 18(9):1225–1233

    Google Scholar 

  3. Bischoff-Ferrari HA, Dawson-Hughes B, Platz A et al (2010) Effect of high dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 170(9):813–820

    Article  PubMed  CAS  Google Scholar 

  4. Magaziner J, Hawkes W, Hebel JR et al (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55(9):M498–507

    Article  PubMed  CAS  Google Scholar 

  5. Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284

    Article  PubMed  CAS  Google Scholar 

  6. Schaller F, Sidelnikov E, Theiler R et al (Sep 2012) Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 51(3):347–352

    Google Scholar 

  7. Birge SJ, Morrow-Howell N, Proctor EK (Nov 1994) Hip fracture. Clin Geriatr Med 10(4):589–609

  8. Cummings SR, Rubin SM, Black D (1990) The future of hip fractures in the US. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop 252:163–166

    PubMed  Google Scholar 

  9. Schurch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP (Dec 1996) A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 11(12):1935–1942

  10. Cawston H, Maravic M, Fardellone P et al (2012) Epidemiological burden of postmenopausal osteoporosis in France from 2010 to 2020: estimations from a disease model. Arch Osteoporos 7(1–2):237–46

    Article  PubMed  CAS  Google Scholar 

  11. Lippuner K, Golder M, Greiner R (Mar 2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16(Suppl 2):S8–S17

    Google Scholar 

  12. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and alpha-hydroxylated vitamin D: a meta-analysis of randomized controlled trial. Br Med J 339:b3692. doi:10.1136/bmj.b3692, BMJ. 2009 Oct 1

    Article  CAS  Google Scholar 

  13. Bischoff-Ferrari HA, Orav EJ, Willett WC et al (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367(1):40–9

    Article  PubMed  CAS  Google Scholar 

  14. IOM (2010) Dietary Reference Ranges for Calcium and Vitamin D. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx (access Feb13.2012)

  15. Dawson-Hughes B, Mithal A, Bonjour JP et al (2010) IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 21(7):1151–1154

    Article  PubMed  CAS  Google Scholar 

  16. Bischoff Ferrari HA (2011) Three steps to unbreakable bones: the 2011 World Osteoporosis Day Report. http://www.iofbonehealth.org//WOD_11/WOD11-Report.pdf (access june 3rd 2012)

  17. Holick MF, Binkley NC, Bischoff-Ferrari HA et al (Jul 2011) Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930

  18. Schweiz BfS (2012) http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/03/blank/key/ind_erw.html. access: 25.5.2012

  19. Bischoff-Ferrari HA, Can U, Staehelin HB et al (Mar 2008) Severe vitamin D deficiency in Swiss hip fracture patients. Bone 42(3):597–602

    Google Scholar 

  20. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J (1999) Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA 281(16):1505–1511

    Article  PubMed  CAS  Google Scholar 

  21. Holick MF (2007) Vitamin D, deficiency. N Engl J Med 357(3):266–281

    Article  PubMed  CAS  Google Scholar 

  22. Harma M, Parviainen M, Koskinen T, Hoikka V, Alhava E (1987) Bone density, histomorphometry, and biochemistry in patients with fractures of the hip or spine. Ann Clin Res 19(6):378–382

    PubMed  CAS  Google Scholar 

  23. Bhan A, Rao AD, Rao DS (2010) Osteomalacia as a result of vitamin D deficiency. Endocrinol Metab Clin North Am 39(2):321–331, table of contents

    Article  PubMed  CAS  Google Scholar 

  24. Aaron JE, Gallagher JC, Nordin BE (1974) Seasonal variation of histological osteomalacia in femoral neck fractures. Lancet 2(7872):84–85

    Article  PubMed  CAS  Google Scholar 

  25. Arnala I, Kyrola K, Kroger H, Alhava EM (1997) Analysis of 245 consecutive hip fracture patients with special reference to bone metabolism. Ann Chir Gynaecol 86(4):343–347

    PubMed  CAS  Google Scholar 

  26. Wilton TJ, Hosking DJ, Pawley E, Stevens A, Harvey L (May 1987) Osteomalacia and femoral neck fractures in the elderly patient. J Bone Joint Surg Br 69(3):388–390

    Google Scholar 

  27. Wilton TJ, Hosking DJ, Pawley E, Stevens A, Harvey L (Nov 1987) Screening for osteomalacia in elderly patients with femoral neck fractures. J Bone Joint Surg Br 69(5):765–768

    Google Scholar 

  28. Cockrell JR, Folstein MF (1988) Mini mental state examination (MMSE). Psychopharmacol Bull 24(4):689–692

    PubMed  CAS  Google Scholar 

  29. Folstein MF, Folstein SE, McHugh PR (1975) Mini mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  PubMed  CAS  Google Scholar 

  30. Bischoff-Ferrari HA, Willett WC, Wong JB et al (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169(6):551–561

    Article  PubMed  CAS  Google Scholar 

  31. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC (Jul 2010) Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 21(7):1121–1132

    Google Scholar 

  32. Gallagher JC, Sai A, Templin T 2nd, Smith L (2012) Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann Intern Med 156(6):425–437

    Article  PubMed  Google Scholar 

  33. Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV (2007) Residual lifetime risk of fractures in women and men. J Bone Miner Res 12:12, Mar 12

    Google Scholar 

  34. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomized controlled trials. BMJ 339(1):b3692

    Article  PubMed  CAS  Google Scholar 

  35. Chan R, Chan CC, Woo J et al (2011) Serum 25-hydroxyvitamin D, bone mineral density, and nonvertebral fracture risk in community-dwelling older men: results from Mr. Os, Hong Kong. Arch Osteoporos 6(1–2):21–30, Dec

    Article  PubMed  Google Scholar 

  36. Bakhtiyarova S, Lesnyak O, Kyznesova N, Blankenstein MA, Lips P (2006) Vitamin D status among patients with hip fracture and elderly control subjects in Yekaterinburg, Russia. Osteoporos Int 17(3):441–446

    Article  PubMed  CAS  Google Scholar 

  37. Nurmi I, Kaukonen JP, Luthje P et al (Dec 2005) Half of the patients with an acute hip fracture suffer from hypovitaminosis D: a prospective study in southeastern Finland. Osteoporos Int 16(12):2018–2024

    Google Scholar 

  38. Inderjeeth CA, Barrett T, Al-Lahham Y, Mulford J, Nicklason F, Reberger C (2002) Seasonal variation, hip fracture, and vitamin D levels in southern Tasmania. N Z Med J 115(1152):183–185

    PubMed  CAS  Google Scholar 

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Conflicts of interest

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Authors and Affiliations

  1. Centre on Aging and Mobility, University of Zurich and Waid City Hospital, Department of Geriatrics and Aging Research, University Hospital Zurich, Gloriastrasse 25, CH-8091, Zurich, Switzerland

    S. Maier, E. Sidelnikov, A. Egli & H. A. Bischoff-Ferrari

  2. Department of Orthopedic Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    S. Maier

  3. USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA

    B. Dawson-Hughes

  4. Department of Rheumatology, City Hospital Triemli, Zurich, Switzerland

    R. Theiler

  5. Department of Traumatology, City Hospital Triemli, Zurich, Switzerland

    A. Platz

  6. Department of Geriatrics, University of Basel, Basel, Switzerland

    H. B. Staehelin

  7. Department of Traumatology, University Hospital, Zurich, Switzerland

    H-P. Simmen

  8. Department of Traumatology, City Hospital Waid, Zurich, Switzerland

    C. Meier

  9. Department of Orthopedic Surgery, Basel University Hospital, Basel, Switzerland

    W. Dick

  10. Department of Geriatrics, City Hospital Waid, Zurich, Switzerland

    D. Grob

  11. Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland

    A. von Eckardstein

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  1. S. Maier
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  2. E. Sidelnikov
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  3. B. Dawson-Hughes
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  4. A. Egli
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  5. R. Theiler
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  6. A. Platz
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  7. H. B. Staehelin
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  9. C. Meier
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  10. W. Dick
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  11. D. Grob
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  13. H. A. Bischoff-Ferrari
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Correspondence to H. A. Bischoff-Ferrari.

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Maier, S., Sidelnikov, E., Dawson-Hughes, B. et al. Before and after hip fracture, vitamin D deficiency may not be treated sufficiently. Osteoporos Int 24, 2765–2773 (2013). https://doi.org/10.1007/s00198-013-2400-z

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  • DOI: https://doi.org/10.1007/s00198-013-2400-z

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