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Vitamin D supplements after hip fracture: Are they prescribed?

Posted on: June 11, 2013   by  Kate Saley

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Low vitamin D levels may not be adequately treated among older hip fracture participants, according to research published in Osteoporosis International.

Hip fractures are the most common fracture among people aged 75 and older. They are also the most serious fracture for older people. Up to 50% of seniors with a hip fracture will have permanent functional disability. Additionally, within the first year after the fracture, 30-50% of hip fracture seniors will be readmitted to acute care. After the age of 75, women have a 1 in 3 chance and men have a 1 in 6 chance of hip fracture. Past research has shown that supplemental vitamin D reduces both falls and hip fracture in older adults.

Researchers surveyed 1000 acute hip fracture patients aged 65 and older who were admitted to a large hospital in Switzerland for hip fracture repair between 2005 and 2010. Eight hundred forty of the participants had vitamin D levels measured upon admission; 360 of which agreed to be followed for one year from the time of their hip fracture.

The researchers were interested in the vitamin D status of participants as well as whether participants were advised to supplement with vitamin D, and if they weren’t, why they weren’t. The authors report the following:

  • Upon hospital admission, mean vitamin D status at the time of hip fracture was 13 ng/ml.
  • Fifty-two percent of participants had vitamin D levels below 10 ng/ml, 80% had levels below 20 ng/ml, and 96% had levels below 30 ng/ml. There was no significant seasonal variation of vitamin D levels. Levels didn’t differ by gender.
  • Nineteen percent of fracture patients received vitamin D at the time of hip fracture. Twenty-seven percent of patients were prescribed vitamin D when they were discharged; this decreased to 22% at 6 months and 21% at 1 year follow-up. The most common treatment strategy was vitamin D plus calcium supplementation.
  • Women were prescribed vitamin D more often than men before their hip fracture, at discharge from acute care, and at 12 month follow-up.
  • Before hip fracture, seniors were equally likely to receive vitamin D regardless of whether they lived at home or in a nursing home. However, after hip fracture, patients who were discharged to a nursing home were half as likely to receive vitamin D supplementation compared to those who were discharged home.

The researchers conducted a small sub-study at 6 months follow-up. They identified 250 participants who were not supplemented with vitamin D and sent letters to 140 of their doctors including a survey for them to explain why they didn’t prescribe vitamin D to their hip fracture patients. The two main reasons identified for not prescribing vitamin D were: “Not mentioned in the discharge letter from acute care” (53%) and “the patient doesn’t want to take vitamin D” (20%).

The fact that doctors aren’t prescribing vitamin D because “vitamin D wasn’t mentioned in the discharge letter” suggests that surgeons need to become an even more integral part of post-hip fracture care, as their recommendation, or lack of recommendation is critical to whether patients receive vitamin D. Additionally, the fact that doctors are less likely to recommend supplementation to patients who are being discharged to a nursing home implies that doctors believe the problem will be addressed by nursing home practitioners.

The current study shows that vitamin D supplementation needs further attention in its use for prevention as well as post-fracture health. The authors recommend an interdisciplinary approach including multiple health care professionals to outline effective supplementation strategies. How do you think the problem can be fixed?

Source

Maier S, et al. Before and after hip fracture, vitamin D deficiency may not be treated sufficiently. Osteoporos Int. 2013.

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