Hypovitaminosis D in Orthopaedic Trauma: Which Guidelines Should Be Followed?

Schiffman, Brett; Summers, Hobie; Bernstein, Mitchell; DiSilvio, Frank; Foyil, Sarah; Lack, William D.

doi:10.1097/bot.0000000000001184

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Based on the results of this phase II screening trial and other available evidence, it remains unclear whether vitamin D 3 supplementation improves fracture healing in nonosteoporotic patients. (26)(27)(28)(29)(30)(31)(32)(33)(34)(35) The use of vitamin D 3 supplementation did improve serum 25(OH)D levels, especially from enrollment to 6 weeks after fracture in all supplementation groups, and our post hoc comparisons suggest high dose supplementation might modestly improve early clinical fracture healing.…”

Section: Discussionmentioning

confidence: 81%

Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

et al. 2022

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Nearly half of adult fracture patients are vitamin D deficient (serum 25‐hydroxyvitamin D [25(OH)D] levels <20 ng/mL). Many surgeons advocate prescribing vitamin D supplements to improve fracture healing outcomes; however, data supporting the effectiveness of vitamin D 3 supplements to improve acute fracture healing are lacking. We tested the effectiveness of vitamin D 3 supplementation for improving tibia and femur fracture healing. We conducted a single‐center, double ‐ blinded phase II screening randomized controlled trial with a 12‐month follow‐up. Patients aged 18–50 years receiving an intramedullary nail for a tibia or femoral shaft fracture were randomized 1:1:1:1 to receive (i) 150,000 IU loading dose vitamin D 3 at injury and 6 weeks ( n = 27); (ii) 4000 IU vitamin D 3 daily ( n = 24); (iii) 600 IU vitamin D 3 daily ( n = 24); or (iv) placebo ( n = 27). Primary outcomes were clinical fracture healing (Function IndeX for Trauma [FIX‐IT]) and radiographic fracture healing (Radiographic Union Score for Tibial fractures [RUST]) at 3 months. One hundred two patients with a mean age of 29 years (standard deviation 8) were randomized. The majority were male (69%), and 56% were vitamin D 3 deficient at baseline . Ninety‐nine patients completed the 3‐month follow‐up. In our prespecified comparisons, no clinically important or statistically significant differences were detected in RUST or FIX‐IT scores between groups when measured at 3 months and over 12 months. However, in a post hoc comparison, high doses of vitamin D 3 were associated with improved clinical fracture healing relative to placebo at 3 months (mean difference [MD] 0.90, 80% confidence interval [CI], 0.08 to 1.79; p = 0.16) and within 12 months (MD 0.89, 80% CI, 0.05 to 1.74; p = 0.18). The study was designed to identify potential evidence to support the effectiveness of vitamin D 3 supplementation in improving acute fracture healing. Vitamin D 3 supplementation, particularly high doses, might modestly improve acute tibia or femoral shaft fracture healing in healthy adults, but confirmatory studies are required. The Vita‐Shock trial was awarded the Orthopaedic Trauma Association's (OTA) Bovill Award in 2020. This award is presented annually to the authors of the most outstanding OTA Annual Meeting scientific paper. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 81%

Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

et al. 2022

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“…population. [23][24][25] Naturally, the increase in serum levels is dependent on patient adherence, which also seems to vary between populations. Andres et al reported 82% of their adult fracture patients were adherent to a daily 1,600 IU vitamin D dose; 25 this is much higher than the 33% of participants that reported taking their supplement daily in our trial.…”

Section: Discussionmentioning

confidence: 99%

Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

Slobogean

Sprague

Bzovsky

et al. 2020

Journal of Orthopaedic Trauma

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Objective: To assess whether fixation method and vitamin D supplementation impact the risk of patient important outcomes within 12 months of injury in non-geriatric femoral neck fracture patients. Design: Pilot factorial randomized controlled trial. Setting: 15 North American clinical sites. Participants: 91 adults aged 18-60 years with a femoral neck fracture requiring surgical fixation. Intervention: Participants were randomized to a surgical intervention (sliding hip screw or cancellous screws) and a vitamin D intervention (vitamin D 3 4,000 IU daily versus placebo for 6 months). Main Outcome Measurements: The primary clinical outcome was a composite of patient important complications (re-operation, femoral head osteonecrosis, severe femoral neck malunion, nonunion). Secondary outcomes included fracture healing complications and radiographic fracture healing.

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Vitamin D and Metabolic Supplementation in Orthopedic Trauma

Nino

Soin

Avilucea

2019

Orthopedic Clinics of North America

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Hypovitaminosis D in Orthopaedic Trauma: Which Guidelines Should Be Followed?

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 6 publications

References 7 publications

Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

Vitamin D and Metabolic Supplementation in Orthopedic Trauma

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Hypovitaminosis D in Orthopaedic Trauma: Which Guidelines Should Be Followed?

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 6 publications

References 7 publications

Effect of Vitamin D3 Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

Effect of Vitamin D3 Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

Vitamin D and Metabolic Supplementation in Orthopedic Trauma

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Product

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Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial

Effect of Vitamin D₃ Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial