The effect of the comorbidity burden on vitamin D levels in geriatric hip fracture

Moo, Ing How; Kam, Carmen Jia Wen; Cher, Eric Wei Liang; Peh, Bryan Ce Jie; Lo, Chung Ean; Chua, David Thai Chong; Lo, Ngai Nung; Howe, Tet Sen; Koh, Joyce Suang Bee

doi:10.1186/s12891-020-03554-1

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…For example, one study found an association between high total serum homocysteine and low methionine levels with more rapid development of cardio vascular multimorbidity 201 . Data on the use of some biomarkers for multimorbidity, such as vitamin D, are conflicting 202,203 .…”

Section: Physiological and Serum Biomarkersmentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

443

283

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Interest in multimorbidity -commonly defined as the co-occurrence of at least two chronic conditions in the same individual 1 -has increased in the past few years owing to its substantial effect on the individual and the individual's family, as well as on health systems and on society, particularly in resource-poor settings 2-4 . Multimorbidity is distinct from the related concept of comorbidity, which refers to the combined effects of additional conditions in relation to the index condition in an individual [5][6][7][8] . By contrast, care for multimorbidity is patient-centred and does not routinely give priority to any single condition, although in clinical care, patients and clinicians will usually focus on the most pressing problems that the patient is experiencing.People with multimorbidity are more likely to die prematurely, be admitted to hospital and have an increased length of stay than people with a single chronic condition 9,10 . Multimorbidity is also associated with poorer function and health-related quality of life (HRQOL), depression and intake of multiple drugs (polypharmacy) and greater socioeconomic costs [11][12][13][14][15][16][17][18] . Most health care is designed to treat individual conditions rather than providing comprehensive, person-centred care 2,19,20 , which often leads to fragmented and sometimes contradictory care for people with multimorbidity and increases their treatment burden 21 Moreover, treating one condition at a time is inefficient and unsatisfactory for both people with multimorbidity and their health-care providers [22][23][24] .Multimorbidity is increasingly common owing to changes in lifestyle risk factors, notably physical inactivity and obesity, and population ageing that in part reflects improvements in survival from acute and chronic conditions 2,19,25,26 . Multimorbidity is associated with socioeconomic status and age 3,19,25,27 . However, although age is the strongest driver of multimorbidity, in absolute numbers, more people <65 years of age have multimorbidity than people ≥65 years of age, partly because more people in the general population are in that age group. Moreover, this emphasizes that multimorbidity is not just a feature of ageing 19,26 .Multimorbidity is further complicated in low-income and middle-income countries (LMICs) by the overlap of compounding factors, including adverse environmental and early life stressors linked to poverty, limited social infrastructure and poorer family coping mechanisms, that translate into chronic diseases occurring at earlier ages [28][29][30][31] . LMICs also have a higher prevalence of multimorbidity-related financial burden 32,33 and have weaknesses in health systems including a greater focus Treatment burdenThe workload associated with managing treatments and health-care recommendations and the impact of this on an individual and their supporters.

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Section: Physiological and Serum Biomarkersmentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

443

283

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“…Multiple mechanisms have been proposed to be responsible for a higher risk of vitamin D insufficiency and deficiency in patients with early stages of CKD, including decreased effectiveness of skin to synthesize vitamin D upon exposure to ultraviolet B in sunlight [35], urinary loss of vitamin D binding protein due to proteinuria [36][37][38], increased 25-hydroxyvitamin D-24-hydroxylase activity as a result of increased serum FGF23 [3], and likely confounding factors such as decreased nutritional vitamin D intake, presence of medical comorbidities, and inadequate sunlight exposure in sick patients [30-33, 39, 40]. This observation could be explained in part by the fact that patients with lower eGFR were in worse medical condition, indicated by the higher Charlson Comorbidity Index (Table 2), as it has been shown that lower serum 25(OH) D level could be a marker of generally poorer health [41]. However, none of the above mechanisms could sufficiently explain the observed dissociation of the prevalence of vitamin D deficiency/insufficiency and mean serum 25(OH)D level in association with kidney function.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D and parathyroid hormone status in community-dwelling elderly patients with mild-to-moderate kidney impairment

Charoenngam

Sriussadaporn

2021

Int Urol Nephrol

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Introduction Evidence on vitamin D and parathyroid hormone (PTH) status in patients with early kidney impairment is limited. We aimed to determine the associations among kidney function, vitamin D, and PTH status in community-dwelling elderly patients with mild-to-moderate kidney impairment. Methods Community-dwelling elderly patients were enrolled in this Institutional Review Board approved cross-sectional study. The eligibility criteria were as follows: age > 60 years, no recent hospitalization within the past 12 months, no conditions that affect vitamin D status including vitamin D supplementation, and eGFR > 30 mL/min/1.73 m 2 . Serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels were assessed. Results A total of 226 patients were enrolled. Data were expressed as mean ± SD. The mean serum 25(OH)D was 26.61 ± 10.44 ng/mL and the mean serum PTH was 50.67 ± 22.67 pg/mL. The prevalence of vitamin D deficiency [25(OH) D < 20 ng/mL] and secondary hyperparathyroidism [PTH > 65 pg/mL] were 25.3% and 18.1%, respectively. Patients with eGFR 30− < 60 mL/min/1.73m 2 had significantly higher prevalence of 25(OH)D < 20 ng/mL (33.7% versus 19.4%, p < 0.05) than patients with eGFR ≥ 60 mL/min/1.73 m 2 . Multiple regression analysis showed independent negative association of serum PTH level with eGFR (mL/min/1.73 m 2 , β: − 0.261, 95% CI [− 0.408, − 0.114]) and serum 25(OH)D (ng/mL, β: − 0.499, 95% CI [− 0.775, − 0.223], adjusted for possible confounders). Conclusions The prevalence of vitamin D deficiency was higher in patients with eGFR 30 -< 60 mL/min/1.73 m 2 than those with eGFR ≥ 60 mL/min/1.73 m 2 . Both decreased serum 25(OH)D levels and decreased eGFR were independently associated with increased serum PTH levels among these patients.

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“…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].…”

Section: Prevalence Of Vitamin D Deficiency In Patients With Osteoporotic Fracturesmentioning

confidence: 99%

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

et al. 2021

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In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.

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The effect of the comorbidity burden on vitamin D levels in geriatric hip fracture

Cited by 8 publications

References 38 publications

Multimorbidity

Multimorbidity

Vitamin D and parathyroid hormone status in community-dwelling elderly patients with mild-to-moderate kidney impairment

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

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