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Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing

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Abstract

Objective

To assess the decrease in serum calcitriol concentrations after hip fracture.

Methods

Serum concentrations of calcitriol, 25(OH)D, parathyroid hormone (PTH), directly measured free 25(OH)D, and indices of bone formation were measured in elderly patients with hip fracture (HF) and patients with elective hip replacement (EHR) at admission and after 7 weeks.

Results

A total of 45 patients with HF and 17 patients with EHR completed this prospective study. Baseline serum calcitriol levels were ≤ 60 pmol/l in 26% of the HF patients. After 7 weeks, they significantly decreased (p < 0.001). In patients with EHR, serum calcitriol was within the reference range in all but one patient and did not change during the 7-week recovery phase. Seven weeks after HF, a significant positive relationship was observed between the change in calcitriol and serum 25(OH)D concentration (r = 0.385, p = 0.009) and free 25(OH)D (r = 0.296, p = 0.048), and a decrease in calcitriol during recovery was associated with a decrease in serum PTH (p = 0.038). Seven weeks after HF, changes in both serum PTH and serum 25(OH)D concentrations contributed to the prediction of changes in serum calcitriol (R2 = 0.190, p = 0.012).

Conclusions

Unlike patients with EHR, subjects with HF had low serum 25(OH)D and low free 25(OH)D concentrations at admission, while their serum 1,25D levels were relatively elevated. Decreases in circulating calcitriol levels in the 7 weeks following hip surgery were associated with a resolution of secondary hyperparathyroidism and low availability of free 25(OH)D.

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Acknowledgment

The authors would like to thank Alena Adamová, Ludmila Hauptvoglová and Tereza Malá for their excellent technical assistance in this project.

Funding

This investigation was supported by the project for conceptual development of research organization 00023728 (Institute of Rheumatology, Prague, Czech Republic).

Author information

Authors and Affiliations

  1. Orthopedic Department, Bulovka Hospital, Prague, Czech Republic

    J. Vaculik & M. Bobelyak

  2. Faculty of Medicine 1, Charles University, Prague, Czech Republic

    J. Vaculik, K. Pavelka & J. J. Stepan

  3. Institute of Rheumatology, Prague, Czech Republic

    L. Wenchich, K. Pavelka & J. J. Stepan

  4. Faculty of Medicine 3, Charles University, Prague, Czech Republic

    J. Vaculik & M. Bobelyak

Authors
  1. J. Vaculik
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  2. L. Wenchich
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  5. J. J. Stepan
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Contributions

JV and MB performed the clinical diagnoses, patients’ follow-up, and data interpretation. LW was responsible for biochemical analysis and data interpretation. KP performed the critical revision of the manuscript. JJS designed the study, was responsible for immunoassays and manuscript preparation. All authors revised the paper critically and approved the manuscript.

Corresponding author

Correspondence to J. J. Stepan.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.

Ethical approval

The study was approved by the institutional review board of the Bulovka Hospital, Prague, Czech Republic. All procedures performed in the present study involving humans were in accordance with the ethical standards of the institution at which the studies were conducted.

Informed consent

All study participants were informed about the research, its purposes and requested to provide written consent of participation.

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Vaculik, J., Wenchich, L., Bobelyak, M. et al. Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing. J Endocrinol Invest 44, 1847–1855 (2021). https://doi.org/10.1007/s40618-020-01489-x

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  • DOI: https://doi.org/10.1007/s40618-020-01489-x

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