Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population

Abstract

Background: Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population. Methods: Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures. Results: The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D <30 ng/mL) and deficiency (25(OH)D <20 ng/mL) was 93.9% and 71.7%, respectively. A significant difference was noted in the prevalence of vitamin D deficiency between patients with and without previous contralateral hip fractures. Age and 25(OH)D levels were found to be correlated, with no correlation between the UV index and the 25(OH)D levels. The 25(OH)D level in the younger population ( n = 123) was 20.7 ± 8.6 ng/mL, which was significantly higher than that of the elderly. Conclusion: Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.

Association of Vitamin D Deficiency with Low Serum Albumin in Taiwanese Older Adults with Hip Fracture: A Prospective Cross-Sectional Study

“…Vitamin D deficiency is particularly prevalent in older adults with hip fracture, but its prevalence varies among the studies conducted. In the present study, over half of the patients were deficient in vitamin D. Table 4 summarizes the results of studies conducted in the last two decades regarding the prevalence of vitamin D deficiency in older adults with hip fracture (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Association between Daily Sunlight Exposure and Fractures in Older Korean Adults with Osteoporosis: A Nationwide Population-Based Cross-Sectional Study

“…This implies that sunlight exposure may play a role in the prevention of fracture independent of serum 25-hydroxyvitamin D. A few studies support this finding. 8 24 One study showed no correlation between UV index and serum 25-hydroxyvitamin D levels in older adults with hip fracture. 24 Furthermore, sunlight exposure may have a direct effect on bone or bone metabolism apart from vitamin D synthesis.…”

“… 8 24 One study showed no correlation between UV index and serum 25-hydroxyvitamin D levels in older adults with hip fracture. 24 Furthermore, sunlight exposure may have a direct effect on bone or bone metabolism apart from vitamin D synthesis. Research has indicated that cumulative increases in sun exposure, independent of vitamin D concentration, have a protective effect against fracture in older females 8 and against osteoporotic fracture in older adults.…”

How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

“…Despite severe vitamin D deficiency below 30 nmol/l being present in the majority of hip fracture patient, only 10% of hip fracture patients had any vitamin D supplementation on admission [ 12 ]. The prevalence of vitamin D deficiency is even higher in patients with previous contralateral hip fractures as compared to those without [ 44 ], suggesting that most surgeons do not prescribe vitamin D to fractured patients. Patients with osteoporotic fractures and/or musculoskeletal symptoms, which can be potentially improved by vitamin D treatment or need the correction of vitamin D deficiency prior to specific treatment, should have serum 25(OH)D levels measured [ 53 ].…”

“…2). Many studies in patients with hip fractures and an average age of around 80 years and over have reported a prevalence of serum 25(OH)D below 50 nmol/l ranging between 34 and 80%, even if mean values are around 40 to 50 nmol/l [12,14,[40][41][42][43][44][45][46][47][48] (Table 1). A high prevalence of vitamin D deficiency was also observed among 219 orthopedic patients presenting with vertebral fragility fractures [49] as well as among 93 patients with pelvic insufficiency fractures [50].…”