Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies

Llombart, R.; Mariscal, G.; Barrios, C.; de la Rubia Ortí, J. E.; Llombart-Ais, R.

doi:10.1007/s40618-023-02266-2

Cited by 4 publications

(2 citation statements)

References 35 publications

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“…For patients admitted with hip fractures, we observed that a 25OHD level ≤19 ng/mL was associated with, on average, 1 day longer of hospitalization, primarily from a prolonged postsurgical LOS. Although this finding is in line with what's reported by Lim et al [ 29 ], association between vitamin D status and LOS after hip fracture appears inconsistent between studies [ 30 ]. Of note, low vitamin D levels showed an inverse association to the LOS among patients underwent elective arthroplastic surgery [ 31 ].…”

Section: Discussionsupporting

confidence: 91%

A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

Sun,

Leder,

Bolster

et al. 2024

Journal of the Endocrine Society

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Context Addressing vitamin D deficiency (VDD) is important for fracture secondary prevention. Objectives To explore the function of a Fracture Liaison Service (FLS) to address VDD. Design, Setting and Patients An observational study of patients admitted to the Massachusetts General Hospital (MGH) with fractures between 1/1/2016 and 10/31/2023 cared for by the FLS. Intervention Ergocalciferol 50,000 international units (50ku-D2) oral daily for 3-7 days. Main Outcomes Measures VDD prevalence. Efficacy of inpatient daily 50ku-D2 in raising serum 25-hydroxyvitamin D (25OHD) levels. Results Of the 2951 consecutive patients, 724 (24.53%) had VDD (defined by 25OHD ≤ 19 ng/ml). Men (252/897, or 28.09%) were more likely than women (472/2054, or 22.98%) to have VDD (p = 0.003). VDD was seen in 41.79% (117/280), 24.41% (332/1360) and 20.98% (275/1311) of patients of ≤59, 60-79, and ≥80 years old, respectively (p < 0.00001). Of the 1303 patients with hip fractures, 327(25.09%) had VDD, which was associated with a longer length-of-stay (LOS) (8.37 ± 7.35 vs. 7.23 ± 4.78 days, p = 0.009) and higher trend of 30-day-readmission (30d-RA) rate (13.63% vs. 18.35%, p = 0.037). In a cohort of 32 patients with complete data, each dose of 50ku-D2 increased serum 25OHD by 3.62 ± 2.35 ng/ml without affecting serum calcium or creatinine levels. Conclusions VDD was seen in nearly 25% of MGH FLS patients and more prevalent in male and younger patients. VDD was associated with longer LOS and higher 30d-RA risk in patients with hip fracture. Daily 50ku-D2 appeared to be a practical way to quickly replete vitamin D in the inpatient setting.

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Section: Discussionsupporting

confidence: 91%

A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

Sun,

Leder,

Bolster

et al. 2024

Journal of the Endocrine Society

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“…Subsequent retrospective analyses confirmed the association between pre-surgical vitamin D deficiency and 6- or 12-month worse physical outcomes, re-admission for medical issues, and re-fracture in elderly subjects [ 78 , 79 , 80 ]. More recently, a meta-analysis of these and other studies in a total of 1972 hip fractured patients aged 78–84 demonstrated that vitamin D deficiency was associated with poorer quality of life and functional ability after fracture, while it did not influence the walking ability and length of stay in the hospital [ 74 ].…”

Section: Vitamin D Status and Hip Fracturesmentioning

confidence: 99%

Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review

Cianferotti,

Bifolco,

Caffarelli

et al. 2024

Nutrients

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Hip fractures are a major health issue considerably impacting patients’ quality of life and well-being. This is particularly evident in elderly subjects, in which the decline in bone and muscle mass coexists and predisposes individuals to fall and fracture. Among interventions to be implemented in hip fractured patients, the assessment and management of nutritional status is pivotal, particularly in subjects older than 65. Nutrition plays a central role in both primary and secondary preventions of fracture. An adequate protein intake improves muscle mass and strength and the intestinal absorption of calcium. Other nutrients with recognized beneficial effects on bone health are calcium, vitamins D, K, and C, potassium, magnesium, folate, and carotenoids. With reference to calcium, results from longitudinal studies showed that the consumption of dairy foods has a protective role against fractures. Moreover, the most recent systematic reviews and meta-analyses and one umbrella review demonstrated that the combination of calcium and vitamin D supplementation significantly reduces hip fracture risk, with presumed higher efficacy in older and institutionalized subjects. Owing to these reasons, the adequate intake of calcium, vitamin D, protein, and other macro and micronutrients has been successfully implemented in the Fracture Liaison Services (FLSs) that represent the most reliable model of management for hip fracture patients. In this narrative review, papers (randomized controlled trials, prospective and intervention studies, and systematic reviews) retrieved by records from three different databases (PubMed, Embase, and Medline) have been analyzed, and the available information on the screening, assessment, and management of nutritional and vitamin D status and calcium intake in patients with hip fractures is presented along with specific prevention and treatment measures.

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Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk

Bayram,

Kanesan,

Clement

2024

Eur J Orthop Surg Traumatol

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Purpose The aims were to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture. Methods A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality. Results The cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l). The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022). Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk. Vitamin D deficiency was not associated with length of hospital stay (median difference 0 days, P = 0.207). Conclusion Vitamin D deficiency was independently associated with increased mortality in hip fracture patients, though this finding may be influenced by lack of comprehensive adjustment for comorbidity. While the value of routine serum vitamin D measurement is debated, supplementation during hospital stays is important to reduce falls and fracture risks associated with deficiency.

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Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies

Cited by 4 publications

References 35 publications

A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review

Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk

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