Skip to main content

Advertisement

SpringerLink
Log in

The short-term impact of vitamin D-based hip fracture prevention in older adults in the United Kingdom

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Vitamin D is a relatively inexpensive drug yet an important hormone in terms of calcium and bone homeostasis. Treatment with vitamin D is associated with reduced fracture risk particularly in an elderly population. Therefore, we assessed the budgetary impact of routine prescription of 800 IU daily colecalciferol on hip fracture among older adults in the United Kingdom.

Methods

Using meta-analysis findings for treatment effect and UK-estimates of incidence, we performed a health economic evaluation of treating the UK population aged 65 and over with 800 IU of vitamin D daily, assessing the impact upon hip fracture costs using incremental attributable costs and excess mortality for a range of age- gender-based treatment strategies.

Results

Using only a 1-year horizon, considering only reduction in hip fracture, prescribing colecalciferol 800 IU daily to all adults aged 65 and over, could reduce the number of incident hip fractures from 65,400 to 45,700, saving almost 1,700 associated deaths, whilst saving the UK taxpayer £22 million.

Conclusions

As the UK government seeks to reduce public expenditure in all sectors, investment in prescribed prophylactic colecalciferol 800 IU therapy for adults aged 65 and over is likely to yield cost savings through reduction hip fracture alone in the first year.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mellanby E (1976) Nutrition Classics. The Lancet 1:407-12, 1919. An experimental investigation of rickets. Edward Mellanby. Nutr Rev 34:338–340

    Article  CAS  PubMed  Google Scholar 

  2. Norman AW (2008) From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 88:491S–499S

    Article  CAS  PubMed  Google Scholar 

  3. Darling AL, Hart KH, Macdonald HM et al (2013) Vitamin D deficiency in UK South Asian Women of childbearing age: a comparative longitudinal investigation with UK Caucasian women. Osteoporos Int 24:477–488

    Article  CAS  PubMed  Google Scholar 

  4. Hyppönen E, Power C (2007) Hypovitaminosis D in British adults at age 45 year: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 85:860–868

    PubMed  Google Scholar 

  5. Schöttker B, Haug U, Schomburg L et al (2013) Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr 25:782–793

    Article  Google Scholar 

  6. Pearce SH, Cheetham TD (2010) Diagnosis and management of vitamin D deficiency. BMJ 340:b5664

    Article  PubMed  Google Scholar 

  7. Lee HJ, Gong HS, Song CH et al (2013) Evaluation of vitamin D level and grip strength recovery in women with a distal radius fracture. J Hand Surg Am 38:519–525

    Article  PubMed  Google Scholar 

  8. Diamond T, Wong YK, Golombick T (2013) Effect of oral cholecalciferol 2,000 versus 5,000 IU on serum vitamin D, PTH, bone and muscle strength in patients with vitamin D deficiency. Osteoporos Int 24:1101–1105

    Article  CAS  PubMed  Google Scholar 

  9. Dhesi JK, Jackson SHD, Bearne LM et al (2004) Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing 33:589–595

    Article  PubMed  Google Scholar 

  10. Muir SW, Montero-Odasso M (2011) Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 59:2291–2300

    Article  PubMed  Google Scholar 

  11. Murad MH, Elamin KB, Abu Elnour NO et al (2011) Clinical review: The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab 96:2997–3006

    Article  CAS  PubMed  Google Scholar 

  12. Cameron ID, Gillespie LD, Robertson MC et al (2012) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 12:CD005465

    PubMed  Google Scholar 

  13. Bischoff-Ferrari HA, Willett WC, Orav EJ et al (2012) A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367:40–49

    Article  CAS  PubMed  Google Scholar 

  14. Davies SC, Jewell T, McBride M, et al. VITAMIN D–ADVICE ON SUPPLEMENTS FOR AT RISK GROUPS. London: Department of Health 2012. https://www.gov.uk/government/publications/vitamin-d-advice-on-supplements-for-at-risk-groups

  15. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Office for National Statistics (2011) Mortality figures for United Kingdom. http://www.statistics.gov.uk/hub/population/deaths/mortality-rates. (Accessed 14 Apr 2013)

  17. NHSBSA Prescription Services. Electronic Drug Tariff. http://www.ppa.org.uk/ppa/edt_intro.htm. (Accessed 14 Apr 2014)

  18. Collins GS, Mallett S, Altman DG (2011) Predicting risk of osteoporotic and hip fracture in the United Kingdom: prospective independent and external validation of Q fracture scores. BMJ 342:d3651

    Article  PubMed Central  PubMed  Google Scholar 

  19. Baker NL, Cook MN, Arrighi HM et al (2011) Hip fracture risk and subsequent mortality among Alzheimer’s disease patients in the United Kingdom, 1988–2007. Age Ageing 40:49–54

    Article  PubMed  Google Scholar 

  20. Parrott S. The Economic Cost of Hip Fracture in the UK. York: 00. http://webarchive.nationalarchives.gov.uk/+/http://www.berr.gov.uk/files/file21463.pdf

  21. HM Treasury (2012) 2012 GDP deflators.http://www.hm-treasury.gov.uk/data_gdp_index.htm. (Accessed 29 Mar 2013)

  22. Nikitovic M, Wodchis WP, Krahn MD et al (2013) Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int 24:659–669

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. XE.com (2013) XE currency conversion. http://www.xe.com/ucc/convert/?Amount=37575&From=CAD&To=GBP. (Accessed 14 Apr 2013)

  24. Kanis JA, Oden A, Johnell O et al (2003) The components of excess mortality after hip fracture. Bone 32:468–473

    Article  CAS  PubMed  Google Scholar 

  25. Office for National Statistics (2012) Death Registrations Summary Tables–England and Wales, 2011 (Final). http://www.ons.gov.uk/ons/rel/vsob1/death-reg-sum-tables/2011-final-/index.html. (Accessed 14 May 2013)

  26. Woolf AD, Akesson K (2003) Preventing fractures in elderly people. BMJ 327:89–95

    Article  PubMed Central  PubMed  Google Scholar 

  27. MHRA. Off-label or unlicensed use of medicines: prescribers’ responsibilities. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON087990. (Accessed 14 Apr 2013)

  28. Leblanc ES, Perrin N, Johnson JD et al (2013) Over-the-counter and compounded vitamin D: is potency what we expect? JAMA Intern Med 173:585–586

    Article  PubMed  Google Scholar 

  29. Garg S, Sabri D, Kanji J et al (2013) Evaluation of vitamin D medicines and dietary supplements and the physicochemical analysis of selected formulations. J Nutr Health Aging 17:158–161

    Article  CAS  PubMed  Google Scholar 

  30. British Orthopaedic Association (2007) The care of patients with fragility fracture. http://www.bgs.org.uk/pdf_cms/pubs/Blue%20Book%20on%20fragility%20fracture%20care.pdf. Accessed 14 Apr 2014

  31. Bebbington A, Darton R, Netten A. Elderly people admitted to residential and nursing homes: 42 months on 2000. http://www.pssru.ac.uk/pdf/p051.pdf

  32. Gutiérrez L, Roskell N, Castellsague J et al (2012) Clinical burden and incremental cost of fractures in postmenopausal women in the United Kingdom. Bone 51:324–331

    Article  PubMed  Google Scholar 

  33. Holt G, Smith R, Duncan K et al (2008) Epidemiology and outcome after hip fracture in the under 65 s-evidence from the Scottish hip fracture audit. Injury 39:1175–1181

    Article  CAS  PubMed  Google Scholar 

  34. Gunasekera N, Boulton C, Morris C et al (2010) Hip fracture audit: the Nottingham experience. Osteoporos Int 21:S647–S653

    Article  CAS  PubMed  Google Scholar 

  35. Autier P, Gandini S (2007) Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 167:1730–1737

    Article  CAS  PubMed  Google Scholar 

  36. Bjelakovic G, Gluud LL, Nikolova D et al (2011) Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 7:CD007470

    PubMed  Google Scholar 

  37. Grey A, Bolland M, Reid I (2012) Vitamin D dose requirements for fracture prevention. N Engl J Med 367:1367–1370

    Article  PubMed  Google Scholar 

  38. Gibson S (2001) Dietary sugars and micronutrient dilution in normal adults aged 65 years and over. Public Health Nutr 4:1235–1244

    Article  CAS  PubMed  Google Scholar 

  39. Bolland MJ, Grey A, Avenell A et al (2011) Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 342:d2040

    Article  PubMed Central  PubMed  Google Scholar 

  40. British Medical Association, Royal Pharmaceutical Society (2013) British National Formulary. 65th edn. BMJ Publishing & Pharmaceutical Press 2013. http://www.bnf.org

Download references

Conflict of interest

Dr Poole has previously consulted for Internis Pharmaceuticals (manufacturer of Fultium-D3), Astellas and Norgine. Dr Davies is a medical advisor to Internis Pharmaceuticals and has undertaken consultancy work for Meda (Manufacturer of Desunin) and Prostrakan (manufacturers of Adcal-D3). Dr Smith has nothing to disclose.

Author information

Authors and Affiliations

  1. Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK

    Chris D. Poole

  2. Torbay Hospital, Torquay, Devon, UK

    Jamie C. Smith

  3. Department of Endocrinology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK

    J. Stephen Davies

Authors
  1. Chris D. Poole
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jamie C. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Stephen Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Stephen Davies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poole, C.D., Smith, J.C. & Davies, J.S. The short-term impact of vitamin D-based hip fracture prevention in older adults in the United Kingdom. J Endocrinol Invest 37, 811–817 (2014). https://doi.org/10.1007/s40618-014-0109-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-014-0109-2

Keywords

Search

Navigation