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

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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Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

Journal of Osteoporosis ◽

10.1155/2015/312952 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Jonathan D. Adachi ◽

Jacques P. Brown ◽

George Ioannidis

Keyword(s):

Vitamin D ◽

Clinical Practice ◽

Bone Health ◽

Chart Review ◽

Serum Vitamin ◽

Vitamin D Supplementation ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

25 Hydroxy Vitamin D ◽

Vitamin D Supplements

Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients’ current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health.

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O02 Is vitamin D testing essential in elderly patients with a hip fracture?

Rheumatology ◽

10.1093/rheumatology/keaa110.001 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Serena N Mehta ◽

Mohd K Omar ◽

Hem Sapkota

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Osteoporosis Treatment ◽

Vitamin D Supplementation ◽

High Dose ◽

Medication History ◽

Vitamin D Levels ◽

High Dose Vitamin

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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Calcium supplementation in osteoporosis: useful or harmful?

Acta Endocrinologica ◽

10.1530/eje-18-0113 ◽

2018 ◽

Vol 178 (4) ◽

pp. D13-D25 ◽

Cited By ~ 14

Author(s):

Iacopo Chiodini ◽

Mark J Bolland

Keyword(s):

Vitamin D ◽

Calcium Supplementation ◽

Fragility Fractures ◽

Cardiovascular Effects ◽

Vitamin D Supplementation ◽

Calcium Balance ◽

Mineral Density ◽

Treatment Of Osteoporosis ◽

Gastrointestinal Side Effects ◽

Vitamin D Supplements

Osteoporosis and fragility fractures are important social and economic problems worldwide and are due to both the loss of bone mineral density and sarcopenia. Indeed, fragility fractures are associated with increased disability, morbidity and mortality. It is known that a normal calcium balance together with a normal vitamin D status is important for maintaining well-balanced bone metabolism, and for many years, calcium and vitamin D have been considered crucial in the prevention and treatment of osteoporosis. However, recently, the usefulness of calcium supplementation (alone or with concomitant vitamin D) has been questioned, since some studies reported only weak efficacy of these supplementations in reducing fragility fracture risk. On the other hand, besides the gastrointestinal side effects of calcium supplements and the risk of kidney stones related to use of co-administered calcium and vitamin D supplements, other recent data suggested potential adverse cardiovascular effects from calcium supplementation. This debate article is focused on the evidence regarding both the possible usefulness for bone health and the potential harmful effects of calcium and/or calcium with vitamin D supplementation.

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Association Between cardiometabolic risk factor and responsiveness to vitamin D supplementation: A New Approach using Artificial Neural Network analysis

10.21203/rs.3.rs-76964/v1 ◽

2020 ◽

Author(s):

Elahe Allahyari ◽

Parichehr Hanachi ◽

Seyed Jamal Mirmoosavi ◽

Gordon A. Ferns ◽

Afsane Bahrami ◽

...

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Cardiometabolic Risk ◽

Serum Vitamin ◽

Vitamin D Supplementation ◽

Cardiometabolic Risk Factor ◽

Baseline Serum ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Artificial Neural

Abstract BackgroundAccumulating data have highlighted the prominence of supplementation as an effective approach for vitamin D deficiency. But individuals vary in their response to vitamin D supplementation. In this study, the effect of cardiometabolic risk factors were evaluate on magnitude of response to vitamin D supplementation by using novel statistical analysis, artificial neural networks(ANNs).Methods608 participants aged between 12 to 19 years old were assed in this prospective interventional study. Nine vitamin D capsules containing 50000IU vitamin D/weekly were given to all participants over the 9 week period. The change in serum 25(OH)D level was calculated as the difference between post-supplementation and basal levels. Suitable ANNs model were selected between different algorithms in the hidden and output layers and different numbers of neurons in the hidden layer. Then, the major determinants in predicting response to vitamin D supplementations were identified (Trial registration: IRCT201509047117N7; 2015-11-25; Retrospectively registered)ResultsSigmoid in both hidden and output layers with 4 hidden neurons had acceptable sensitivity, specificity and accuracy area under the ROC curve in our study. Baseline serum vitamin D (30.4%), waist to hip ratio (10.5%), BMI (10.5%), systolic blood pressure (8%), heart rate (6.4%), and waist circumference (6.1%) were the greatest importance in predicting the response in serum vitamin D levels. ConclusionWe provide the first attempt to relate anthropometric specific recommendations to attain serum vitamin D targets. With the exception of cardiometabolic risk factor, the relative importance of other factors and the mechanisms by which these factors may affect the response requires further analysis in future studies.

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A170 VITAMIN D IN IBD PATIENTS – A RETROSPECTIVE REVIEW

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.169 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 35-36

Author(s):

R A MacMillan ◽

T Ponich

Keyword(s):

Vitamin D ◽

Bone Density ◽

Disease Severity ◽

Regression Coefficient ◽

Serum Vitamin ◽

Vitamin D Supplementation ◽

Serum Vitamin D ◽

Mayo Score ◽

Vitamin D Levels ◽

Low Serum

Abstract Background Vitamin D is a critical factor in bone remodelling, calcium absorption and may promote anti-inflammatory cytokines in the gut. Inflammatory bowel disease (IBD) is associated with a reduction in serum Vitamin D levels and a chronic inflammatory state, both of which are strong risk factors for bone density loss affecting IBD patients. Despite European and North American IBD maintenance guidelines for Vitamin D monitoring and bone density scans, there are limited North American investigations into factors influencing serum Vitamin D levels in the IBD patient population specifically. Aims We investigated whether patient demographics, disease severity indexes and/or inflammatory markers were linked to low serum Vitamin D levels in our IBD patients. We also established the extent of Vitamin D serum deficiencies and supplementation rates in our IBD patients. Methods A retrospective chart review of a single clinician’s practice at London Health Science Centre, Victoria Hospital, over the past 20 months, was performed to: 1) assess the frequency of low serum 25-OH Vitamin D (25-OH D) in the IBD patient population and 2) determine whether patient disease severity was linked to lower 25-OH D levels. A multivariate regression analysis was performed assessing Crohn’s Disease (CD) or Ulcerative Colitis (UC) patient factors: age, sex, disease duration, seasonality, current pharmacologic treatments, past surgeries, CD Activity Index, UC Mayo score, C-reactive protein, and fecal calprotectin (Fcal) level. Results 175 IBD patients had at least one 25-OH D measurement with 71 patients actively on Vitamin D therapy. Of UC and CD patients who were not on Vitamin D therapy, 63% (17/27) and 79% (61/77) were 25-OH D deficient, respectively. 25-OH D levels in the CD population was associated with Vitamin D supplementation (regression coefficient [RC] 23.99, 95% confidence interval [CI] 14.54 to 33.45), summer season ([RC] 9.90, [CI] 0.56 to 19.24), and past bowel resection ([RC] -10.61, [CI] -20.48 to -0.76). 25-OH D levels in the UC population was associated with Vitamin D supplementation (regression coefficient [RC] 47.23, 95% confidence interval [CI] 27.62 to 66.83), and Mayo severity scores ([RC] -23.01, [CI] -41.82 to -4.20). Fcal (78 patients) was inversely associated with 25-OH D levels but the trend was not significant. Conclusions Overall, 25-OH D levels were lower in both the UC and CD patient populations relative to the already deficient Canadian population. However, IBD patients are responsive to Vitamin D supplementation. Tools with more objective evidence of disease severity such as UC Mayo score and fcal should be prioritized for identifying the IBD population requiring supplementation. Funding Agencies None

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Vitamin D Supplementation to Treat Statin-Associated Muscle Symptoms: A Review

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.253 ◽

2019 ◽

Vol 34 (4) ◽

pp. 253-257

Author(s):

Kimberly Lowe ◽

Khadija Tul Kubra ◽

Ze Yang He ◽

Katherine Carey

Keyword(s):

Vitamin D ◽

Statin Therapy ◽

Serum Vitamin ◽

Signs And Symptoms ◽

The United States ◽

Vitamin D Supplementation ◽

Serum Creatine Kinase ◽

Serum Vitamin D ◽

The Past ◽

Vitamin D Supplements

For the past 15 years, cardiovascular disease (CVD) has been the leading cause of death for both men and women in the United States and worldwide. With an aging population, there has been increasing use of statin therapy to reduce the risk of CVD. However, statin-associated muscle symptoms (SAMS) remain an obstacle to this treatment, leading to discontinuation and nonadherence to statin therapy. Signs and symptoms of SAMS include muscle pain, tenderness, and increased serum creatine kinase. Despite the idiopathic pathophysiology of SAMS, some studies have shown an association between vitamin D deficiency and SAMS; the use of vitamin D supplements can lead to relief of these symptoms. The purpose of this review was to critique evidence for the association between low serum vitamin D and SAMS and the use of vitamin D supplementation for treatment.

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