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Published on: January 29, 2018
Vitamin D status and complications, readmissions, and mortality after hip fracture
F Ingstad1,2, L B Solberg3, L Nordsletten3,4
1Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway. frida-2112@hotmail.com.
Insights
Low vitamin D levels in hip fracture patients are common and increase risks for delirium, new fractures, and readmissions. Supplementation may help prevent orthopedic complications, warranting further investigation.
Area of Science:
- Orthopedics
- Endocrinology
- Geriatrics
Background:
- Low vitamin D (serum calcidiol < 50 nmol/L) affects 47% of hip fracture patients.
- Vitamin D deficiency is linked to adverse outcomes post-hip fracture.
Purpose of the Study:
- To investigate the association between vitamin D levels and postoperative complications in hip fracture patients.
- To evaluate the impact of a single 100,000 IU cholecalciferol dose on outcomes.
Main Methods:
- Analysis of data from a local hip fracture registry.
- Logistic regression models were used to assess the relationship between vitamin D levels and complications/readmissions, adjusting for confounders.
Main Results:
- Vitamin D deficiency (47% of 872 patients) was associated with higher risks of delirium (OR 1.48), new hip fractures (OR 2.84), and medical readmissions within 30 days (OR 1.64) and 12 weeks (OR 1.47).
- No correlation was found between baseline vitamin D and orthopedic complications.
- Patients receiving cholecalciferol supplementation showed fewer orthopedic complications within 30 days (OR 0.32).
Conclusions:
- Low vitamin D levels in hip fracture patients correlate with increased risks of delirium, subsequent hip fractures, and medical readmissions.
- The potential benefit of vitamin D supplementation in preventing orthopedic complications requires additional research.
Abstract:
Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year.
Introduction:
We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU.
Methods:
Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions.
Results:
A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery.
Conclusion:
Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.
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