Low vitamin D levels and normal bone biochemistry—is it common? A survey in elderly patients after hip fracture from Stockport, UK

Abstract Background Elderly patients with hip fractures are likely to be vitamin D deficient. As per some studies, a vitamin D level above 75nmol/L is considered to be sufficient for this cohort. The majority of these patients will require treatment for their osteoporosis. Prior to treatment, vitamin D levels need to be sufficient, however there is often a delay to obtain vitamin D test results and this can postpone the initiation of osteoporosis management. In this retrospective study, we hypothesised whether empirical, high dose vitamin D treatment can be given to patients with hip fractures, regardless of their vitamin D level, who are not currently on vitamin D supplementation. Methods We obtained a list of 917 patients with a hip fracture, aged over 50, from the Trust National Hip Fracture Database from January 2017 to December 2018. We accessed patients’ electronic hospital and GP records to collect patient demographics, vitamin D levels, and medication history. Results The mean age in this study was 82.7 years, and 69.8% were female. Vitamin D levels were available for 666 patients. Of this, 69.9% of patients had a below adequate level (50 nmol/L) and 88.4% of patients had a below sufficient level (75 nmol/L) of vitamin D. Electronic records for vitamin D supplementation were only available for 434 patients. Of this, 300 patients (69.1%) were not on any form of vitamin D supplementation. In this cohort, only 7 patients had a vitamin D level above sufficient levels (75 nmol/L). Upon contacting these 7 patients; 3 were taking some form of vitamin D supplementation, 3 died and no information was available for 1. Conclusion Our study demonstrates all patients with a hip fracture, who are not taking any form of vitamin D supplementation will have subtherapeutic vitamin D levels. Thus, patients presenting with a hip fracture, can be treated empirically with high dose vitamin D treatment, without prior vitamin D testing. This would reduce the number of vitamin D tests conducted by 69.1% which will enable patients to receive prompt osteoporosis treatment and will reduce costs. Disclosures S.N. Mehta None. M.K. Omar None. H. Sapkota None.

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Elderly patients with trochanteric hip fracture have lower serum Vitamin D levels compared to patients with cervical hip fracture

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2010.03.023 ◽

2011 ◽

Vol 52 (1) ◽

pp. e15-e18 ◽

Cited By ~ 7

Author(s):

Olga E. Dretakis ◽

Andrew N. Margioris ◽

Christos Tsatsanis ◽

Konstantin E. Dretakis ◽

Niki Malliaraki ◽

...

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Serum Vitamin ◽

Lower Serum ◽

Serum Vitamin D ◽

Vitamin D Levels

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Vitamin D and Calcium Supplementation in Elderly Patients Suffering Fragility Fractures; The Road not Taken

The Open Orthopaedics Journal ◽

10.2174/1874325001711011230 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1230-1235 ◽

Cited By ~ 1

Author(s):

Aaron K. Saini ◽

Edward J.C. Dawe ◽

Simon M. Thompson ◽

John W. Rosson

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Fragility Fracture ◽

Calcium Supplementation ◽

Serum Vitamin ◽

Fragility Fractures ◽

Vitamin D Supplementation ◽

Vitamin D Levels ◽

Vitamin D Supplements

Background: Calcium and Vitamin D supplementation in elderly patients may decrease the risk of hip fracture by up to one-third. Many patients suffering fragility fractures do not go on to receive this treatment despite clear recommendations from the National Institute for Health and Clinical Excellence (NICE). The aim of this study was to audit the proportion of patients admitted with a hip fracture who had suffered a previous fragility fracture and were taking calcium and vitamin D supplements, with the standard being that all of these patients should have been taking bone protection. We also aimed to assess the Vitamin D levels of patients admitted with a hip fracture to our unit. Methods: Patients were prospectively added to a database over a 12-month period. Serum vitamin D levels (25-OH D3) were measured on admission and case-notes were reviewed for pre-injury social function and mobility. Results: 147 patients were included in the study. Median age was 85 years (Interquartile range 79 – 90 (Range 53 – 100 years)). Only eighteen patients (11.4%) were taking calcium and vitamin D supplementation on admission. Forty seven patients (29%) had documented evidence of a previous fragility fracture within the last seven years. Only fourteen of these patients (19%) were receiving calcium and vitamin D supplementation. One hundred and twenty two patients were deficient in Vitamin D (76%). Twenty five patients (16%) had insufficient Vitamin D. Only the remaining 14 patients (8%) had sufficient vitamin D. Conclusion: Vitamin D deficiency is endemic amongst patients suffering hip fractures. Very few patients who had suffered a previous fragility fracture were taking Calcium and Vitamin D supplements when admitted with a hip fracture several years later. This is an opportunity missed.

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The effect of vitamin-d levels on prognosis of elderly patients treated in intensive care unit

Journal of Contemporary Medicine ◽

10.16899/jcm.705176 ◽

2020 ◽

Vol 10 (1) ◽

pp. 13-17

Author(s):

Hülya YİĞİT ÖZAY ◽

İbrahim MUNGAN ◽

Güneş ÇOBANOĞLU ERCAN ◽

Sema TURAN ◽

Banu ELER ÇEVİK

Keyword(s):

Intensive Care Unit ◽

Vitamin D ◽

Intensive Care ◽

Elderly Patients ◽

Vitamin D Levels

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A cross sectional study on correlation of vitamin D levels with types of proximal femoral fractures in elderly patients

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i3n.2132 ◽

2019 ◽

Vol 5 (3) ◽

pp. 834-836

Author(s):

Dr. Vavilapalli Ramesh ◽

Dr. Aneepu Siva Prasad ◽

Dr. Baruva Komala Rao ◽

Dr. Aneepu Siva Prasad

Keyword(s):

Vitamin D ◽

Elderly Patients ◽

Femoral Fractures ◽

Cross Sectional Study ◽

Proximal Femoral Fractures ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin D Levels

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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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25-Hydroxyvitamin D levels in serum at the onset of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1157oa ◽

2005 ◽

Vol 11 (3) ◽

pp. 266-271 ◽

Cited By ~ 157

Author(s):

M Soilu-Hänninen ◽

L Airas ◽

I Mononen ◽

A Heikkilä ◽

M Viljanen ◽

...

Keyword(s):

Vitamin D ◽

Bone Metabolism ◽

Sun Exposure ◽

Serum Levels ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Normal Bone ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Lower Vitamin

Past sun exposure and vitamin D supplementation have been associated with a reduction in the risk of MS. We measured the serum concentration of 25-hydroxyvitamin D (25[OH]D) at the time of MS diagnosis in 40 MS patients and 40 controls. We found no difference in the serum levels of 25(OH)D between MS patients and controls when all samples or samples obtained during winter months were compared, but MS patients had significantly lower serum 25(OH)D concentrations in June to September than the controls. The vitamin D stores were adequate for bone metabolism (> 37 nmol/L) in 70% of MS patients throughout the year and within the hypovitaminosis level (< 37 nmol/L) in 30% of MS patients at some time of the year. During MS-relapses, 25(OH)D levels were lower than in remission, but mostly within the reference range observed in relation with normal bone metabolism. We conclude that the vitamin D stores in most MS patients are adequate for their normal bone metabolism. However, lower vitamin D levels during MS relapses than in remission suggest that vitamin D could be involved in the regulation of the clinical disease activity of MS. The optimal serum levels of vitamin D for the regulation of immune responses remain to be determined.

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Association of 25-OH vitamin D deficiency with worse outcome for elderly patients with aggressive B-cell lymphomas treated with CHOP plus rituximab (R): An analysis of the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.8569 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 8569-8569

Author(s):

Joerg Thomas Bittenbring ◽

Marina Achenbach ◽

Bettina Altmann ◽

Marita Ziepert ◽

Joerg Reichrath ◽

...

Keyword(s):

Vitamin D ◽

Elderly Patients ◽

B Cell ◽

Vitamin D Deficiency ◽

Prospective Trial ◽

Multivariable Analysis ◽

Serum Levels ◽

B Cell Lymphomas ◽

Vitamin D Levels ◽

25 Oh Vitamin D

8569 Background: Vitamin D deficiency was shown to be is associated with a worse outcome in patients with non-Hodgkin's lymphoma (Drake et al., 2010) To study whether this observation could be confirmed in patients with aggressive B-cell lymphomas treated uniformly within a prospective trial, we analyzed 25-OH vitamin D serum levels in patients treated within the RICOVER-60 trial of the DSHNHL. Methods: 25-OH Vitamin D serum levels were determined with a commercial chemoluminescence immunoassay in the serum from elderly patients of the RICOVER-60 trial which compared 6 or 8 cycles of CHOP, both with and without rituximab. Results: 193 of 359 pts (53.8%) had vitamin D deficiency (<10 ng/ml) and 165/359 patients (46.0%) had vitamin D insufficiency (10-30 ng/ml) according to current definitions. When treated with R-CHOP, patients with vitamin D levels ≤8 ng/ml had a 3-year EFS of 59% compared to 79% of patients with vitamin D serum levels >8 ng/ml; the respective figures for 3-year overall survival were 70% and 82%, respectively. In R-CHOP pts these differences were significant in a multivariable analysis adjusting for IPI risk factors with a hazard ratio (HR) of 2.1 (p=0.008) for EFS and a HR of 1.9 (p=0.040) for OS. In pts treated without R effects of vitamin D deficiency were significant only for OS (HR 1.8; p=0.025), but not with respect to EFS (HR 1.2; p=0.388). These results were confirmed in an independent validation set of 63 patients treated within the prospective RICOVER-noRx study. Conclusions: Vitamin D deficiency is a significant risk factor for patients with aggressive B-cell lymphomas treated with R-CHOP. The stronger adverse effect of vitamin D deficiency in patients receiving rituximab suggests that vitamin D deficiency interferes with the R mechanisms of this antibody. A prospective study evaluating the effects of vitamin D substitution on outcome of patients receiving R-CHOP is warranted. Supported by Deutsche Krebshilfe.

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