Getting hip to vitamin D: A hospitalist project for improving the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture

Background: Low concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery.Methods: Between January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism.Results: The mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11-1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group.Conclusions: Preoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

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Prevalence and Clinical Correlation of Vitamin D Inadequacy in Traumatic Hip Fracture among Elderly Patients

Journal of Orthopedics & Bone Disorders ◽

10.23880/jobd-16000191 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-8

Author(s):

Phruetthiphat O

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Vitamin D Deficiency ◽

Orthopedic Surgery ◽

Normal Population ◽

Mechanical Failure ◽

Vitamin D Status ◽

Clinical Correlation ◽

Ambulatory Status

Introduction : High prevalence of vitamin D deficiency has been described in more than 1 billion people around the world, es pecially in Middle - East and Asia. In Thailand, the largest study of vitamin D status in normal population (N=2641) identified overall 45.2 percent of vitamin D inadequacy in normal population. However, there was no study focusing on Vitamin D inadequacy in traumatic elderly patients. The purpose of this study is going to define the prevalence of vitamin D inadequacy in traumatic hip fracture among elderly patients and to identify a clinical correlation. Materials and Methods : A prospective study of elderly patients (more than 60 years old) with low energy trauma who underwent orthopaedic surgery at Phramongkutklao Hospital between the period of January 2016 and December 2016. All hip fracture patients underwent orthopedic surgery were collected for demograph ic data, comorbidities including Charlson Comorbidity Index. Primary outcome was to identify a prevalence of vitamin D inadequacy (<30 ng/ml) and vitamin D deficiency (<20 ng/ml) in hip fracture underwent orthopedic surgery. Secondary outcome was to define association of demographic data, comorbidity with vitamin D level. Additionally, comparison the ambulatory status and mechanical failure between normal vitamin D and vitamin D inadequacy Results : The serum 25(OH)D levels for this study was normally distri buted, with a mean of 25.0±12.2 ng/ml in all patients, Prevalence of vitamin D inadequacy was 70.5 percent (n=103) and the prevalence of vitamin D deficiency was 37.7 percent (n=55). There was no significant difference of ambulatory status between vitamin D inadequacy and sufficient vitamin D groups (p=0.958). Additionally, there was not different in mechanical failure between groups (4.5% and 0%, p=1.000). Conclusion : Vitamin D inadequacy is so common in traumatic elderly patients. We should raise attentiveness among physician to determine vitamin D status. Public health strategy should add knowledge about diet, supplements or adequate sun exposure to elderly population . Vitamin D inadequacy did not affect the outcome including time to union and ambulatory status at 1 year follow up.

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Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture

Journal of Bone Metabolism ◽

10.11005/jbm.2015.22.4.205 ◽

2015 ◽

Vol 22 (4) ◽

pp. 205 ◽

Cited By ~ 3

Author(s):

Gyeong-Hak Lee ◽

Jung-Won Lim ◽

Yong-Gum Park ◽

Yong-Chan Ha

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Strong Risk Factor

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High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.569 ◽

2013 ◽

Vol 95 (8) ◽

pp. 569-572 ◽

Cited By ~ 25

Author(s):

JA Jansen ◽

FS Haddad

Keyword(s):

Vitamin D ◽

Total Knee Replacement ◽

Elderly Patients ◽

Knee Osteoarthritis ◽

Vitamin D Deficiency ◽

Knee Replacement ◽

Functional State ◽

High Prevalence ◽

Outcome Scores ◽

Total Knee

Vitamin D deficiency has been reported previously in patients with osteoarthritis undergoing total hip arthroplasty. We found a high prevalence of vitamin D deficiency in elderly patients with advanced knee osteoarthritis scheduled for total knee replacement and also a significant association with a lower preoperative functional state. A review of the literature is given on vitamin D deficiency in patients with knee osteoarthritis and the association with lower outcome scores after arthroplasty is discussed.

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Vitamin D Levels and Nutritional Risk Index: Mobility and Mortality After Hip Fracture Surgery (P01-013-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-013-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lihong Hao ◽

Yvette Schlussel ◽

Jeffrey Carson ◽

Sue Shapses

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Risk Index ◽

Nutritional Risk ◽

Walking Ability ◽

Hip Fracture Surgery ◽

Vitamin D Levels ◽

Nutritional Risk Index ◽

Fracture Surgery

Abstract Objectives Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. This study aims to determine whether 25-hydroxyvitamin D (25(OH)D) or the Geriatric Nutritional Risk Index (GNRI) is associated with short term mortality or ability to walk after hip fracture surgery. Methods Patients undergoing hip fracture repair were included in this study. Mortality and walking ability were assessed at 30 and 60 days after hip fracture surgery. Pre-operative serum albumin and 25(OH)D were measured. Patients were characterized with 25(OH)D <12 ng/mL, 12 to <20, 20 to <30 or ≥30. GNRI was calculated from albumin and body weight and patients were categorized into major/moderate nutritional risk (<92), low risk (92 to <98) or in good nutritional status (≥98). Results Of the 290 patients (82 ± 7 years, BMI 25 ± 5 kg/m2), 73% were females. Compared to patients with vitamin D deficiency (<12 ng/mL), those with vitamin D levels in higher categories had increased ability to walk at 30 days (P = 0.031): 12 to <20 ng/ml (adjusted odds ratio = 2.61; 95% confidence interval = 1.13–5.99); 20 to <30 ng/ml (3.48; 1.53–7.95); ≥30 ng/ml (2.84; 1.12–7.20). In addition, patients also had increased mobility at 60 days in these same higher vitamin D categories 12 to <20 (2.67; 1.14–6.25); 20 to <30 (3.42; 1.46–8.00); ≥30 ng/ml (3.67; 1.37–9.82) compared to the reference group (<12 ng/mL; P = 0.028). There was no association of vitamin D with mortality at either time point. GNRI was not associated with mortality or walking ability. Conclusions In patients with hip fracture, vitamin D deficiency (<12 ng/mL) was associated with reduced ambulation after surgery, whereas GNRI was not associated with any outcomes. Mechanisms that attenuate mobility due to vitamin D deficiency should be examined in future studies. Funding Sources ONE Nutrition Grant to SAS and JLC.

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