Archives of orthopaedic and traumatic surgery

, Volume 103, Issue 6, pp 408–416 | Cite as

High incidence of low serum vitamin D concentration in patients with hip fracture

  • E. Harju
  • E. Sotaniemi
  • J. Puranent
  • R. Lahti
Original Articles

Summary

The study of 82 consecutive hip fracture patients (22 males and 60 females) and 185 various controls showed that low serum 25-OH-vitamin D3 (25-OD-D3) concentration was common in the hip fracture patients, who in addition were old, incapable of independent daily life, had poor dietary habits, reduced nutritional status, and spent insufficient time in sunlight. The most usual mechanisms of trauma were minor indoor falls. Osteoporosis was common and associated with low 25-OH-D3. Hypocalcemia was more common in hip fracture patients than in controls. Increased serum alkaline phosphatase was not a specific feature in hip fracture patients. The results suggest that vitamin D supplementation is indicated in elderly disabled people.

Keywords

Disable People Serum Alkaline Phosphatase Usual Mechanism Poor Dietary Habit Increase Serum Alkaline Phosphatase 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Zusammenfassung

Die Untersuchung einer geschlossenen Serie von 82 Patienten mit Huftfrakturen (22 männlich, 60 weiblich) und von 185 verschiedenen Kontrollfällen haben gezeigt, daß bei Patienten mit Hüftfrakturen häufig eine niedrige Serum-Konzentration von 25-OH-Vitamin D3 (25-OH-D3) bestand. Zusätzlich bestanden bei diesen Patienten ein hohes Lebensalter, Pflegebedürftigkeit, mangelhafte Ernährungsgewohnheiten, ein reduzierter Ernährungszustand und sie waren dem Sonnenlicht ungeniigend ausgesetzt. Den häufigsten Unfallmechanismus stellten leichtere Sturze in der Wohnung dar. Häufig bestand eine Osteoporose in Verbindung mit einem niedrigen 25-OH-D3-Spiegel. Eine Hypokalzamie war bei den Patienten mit Hüftfrakturen häufiger als bei den Kontrollfällen, während die Konzentration der alkalischen Phosphatase nicht ein spezifisches Verhalten zeigte. Die Untersuchungsergebnisse legen bei älteren behinderten Menschen nahe, eine Vitamin D-Zufuhr durchzuführen.

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References

  1. 1.
    Alffram P-A (1964) An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population. Acta Orthop Scand [Suppl] 65Google Scholar
  2. 2.
    Alhava EM, Puittinen J (1973) Fractures of the upper end of the femur as an index of senile osteoporosis in Finland. Ann Clin Res 5:398–403Google Scholar
  3. 3.
    Anderson I, Campbell AER, Dunn A, Runciman JBM (1966) Osteomalacia in elderly women. Scott Med J 11:429–435Google Scholar
  4. 4.
    Annino JS (1964) Clinical chemistry. Principles and procedures, 3rd ed. Little, Brown, Boston, pp 120–121Google Scholar
  5. 5.
    Baker MR, McDonnell H, Peacock M, Nordin BEC (1979) Plasma 25-hydroxyvitamin D concentrations in patients with fractures of the femoral neck. Br Med J 1:589Google Scholar
  6. 5a.
    Belsey RE, DeLuca HF, Potts JT Jr (1974) A rapid assay for 25-OH-vitamin D3 without preparative chromatography. J Clin Endocrinol Metab 38:1046–1051Google Scholar
  7. 6.
    Bessey OA, Lowry OH, Brock MJ (1946) A method for the rabid determination of alkaline phosphatase with five cubic millimetres of serum. J Biol Chem 164:321–329Google Scholar
  8. 7.
    Bollet AJ, Engh G, Parson W (1965) Epidemiology of osteoporosis. Arch Intern Med 116:191–194Google Scholar
  9. 8.
    Brown LRF, Bakowska A, Millard PH (1976) Vitamin D status of patients with femoral neck fractures. Age Ageing 5:127–131Google Scholar
  10. 9.
    Chalmers J, Ho KC (1970) Geographical variations in senile osteoporosis. J Bone Joint Surg [Br] 52:667–675Google Scholar
  11. 10.
    Chalmers J, Conacber WDH, Gardner DL, Scott PJ (1967) Osteomalacia a common disease in elderly women. J Bone Joint Surg [Br] 49:403–423Google Scholar
  12. 11.
    Daw CJ, Gray DH, Hardy AE, Speak K (1979) Osteomalacia and femoral neck fractures. J Bone Joint Surg [Br] 61:385–386Google Scholar
  13. 12.
    DeLuca HF (1979) The vitamin D system in the regulation of calcium and phosphorus metabolism. Nutr Rev 37:161–193Google Scholar
  14. 13.
    DeLuca HF, Schnoes HK (1976) Metabolism and mechanism of action of vitamin D. Ann Rev Biochem 45:631–653Google Scholar
  15. 14.
    Eid AM, Orth MC (1978) Osteomalacia as a contributing factor in fracture of the femoral neck in the elderly in Qatar. Clin Orthop 132:129–135Google Scholar
  16. 15.
    Engh G, Bollet AJ, Hardin G, Parson W (1968) Epidemiology of osteoporosis. II. Incidence of hip fractures in mental institutions. J Bone Joint Surg [Am] 50:557–562Google Scholar
  17. 16.
    Floch MH (1981) In: Nutrition and diet therapy in gastrointestinal disease: P 480. Plenum, New York, p 65Google Scholar
  18. 17.
    Harju E (1981) Dietary habits and factors influencing them in selected Finnish groups. Acta Univ Oulu D 71Google Scholar
  19. 18.
    Hoikka V, Alhava EM, Savolainen K, Parviainen M (1982) Osteomalacia in fractures of the proximal femur. Acta Orthop Scand 53:255–260Google Scholar
  20. 19.
    Hosking DJ (1978) Changes in serum alkaline phosphatase after femoral fractures. J Bone Joint Surg [Br] 60:61–65Google Scholar
  21. 20.
    Inman VT (1947) Functional aspects of the abductor muscles of the hip. J Bone Joint Surg 29:607–619Google Scholar
  22. 20a.
    Jenkins DHR, Roberts JG, Webster D, Williams EO (1973) Osteomalacia in elderly patients with fracture of the femoral neck: a clinico-pathological study. J Bone Joint Surg [Br] 55:575–580Google Scholar
  23. 21.
    Knowelden J, Buhr AJ, Dunbar O (1964) Incidence of fractures in persons over 35 years of age. Br J Prev Soc Med 18:130–141Google Scholar
  24. 22.
    Leitch IH, Knowelden J, Seddon HJ (1964) Incidence of the fractures, particularly of the neck of the femur, in patients in mental hospitals. Br J Prev Soc Med 18:142–145Google Scholar
  25. 23.
    Levine S, Makin M, Menczel J, Robin G, Naor E, Steinberg R (1970) Incidence of fractures of the proximal end of the femur in Jerusalem. J Bone Joint Surg [Am] 52:1193–1201Google Scholar
  26. 23a.
    Lewinnek GE, Kelsey J, White AA, Kreiger NJ (1980) The significance and a comparative analysis of the epidemiology of hip fractures. Clin Orthop Rel Res 152:35–43Google Scholar
  27. 24.
    Lund B, Sorensen OH, Lund B, Melsen F, Mosekilde L (1982) Vitamin D, metabolism and osteomalacia in patients with fractures of the proximal femur. Acta Orthop Scand 53:251–254Google Scholar
  28. 25.
    Newton-John HF, Morgan DB (1970) The loss of bone with age, osteoporosis, and fractures. Clin Orthop 71:229–252Google Scholar
  29. 26.
    Niemann KM, Mankin HJ (1968) Fractures about the hip in an institutionalized patient population. J Bone Joint Surg [Am] 50:1327–1340Google Scholar
  30. 27.
    Nilsson BE, Westlin NE (1972) The plasma concentration of alkaline phosphatase, phosphorus and calcium following femoral neck fracture. Acta Orthop Scand 43:504–510Google Scholar
  31. 28.
    Singh M, Nagrath AR, Maini PS (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg [Am] 52:457–467Google Scholar
  32. 28a.
    Snedecor GW, Cochran WG (1971) Statistical methods, 6th edn. Ames, IowaGoogle Scholar
  33. 29.
    Solomon L (1968) Osteoporosis and fracture of the femoral neck in the South African Bantu. J Bone Joint Surg [Br] 50:2–13Google Scholar
  34. 30.
    Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti RO (1972) Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy. Ann Intern Med 77:389–394Google Scholar
  35. 31.
    Steenbock H (1924) The induction of growth promoting and calcifying properties in a rat by exposure to light. Science 60:224–225Google Scholar
  36. 32.
    Steenbock H, Black A (1924) Fat-soluble vitamins. XVII. The induction of growth-promoting and calcifying properties in a rat by exposure to ultraviolet light. J Biol Chem 61:405–422Google Scholar
  37. 33.
    Stevens J, Freeman PA, Nordin BEC, Barnett E (1962) The indicence of osteoporosis in patients with femoral neck fracture. J Bone Joint Surg [Br] 44:520–527Google Scholar
  38. 34.
    Weisman Y, Salama R, Harell A (1978) Serum 24,25-dihydroxyvitamin D and 25-hydroxyvitamin D concentrations in femoral neck fracture. Br Med J 2:1196–1197Google Scholar
  39. 35.
    Wicks M, Garrett R, Vernon-Roberts B, Fazzalari N (1982) Absence of metabolic bone disease in the proximal femur in patients with fracture of the femoral neck. J Bone Joint Surg [Br] 64:319–322Google Scholar
  40. 36.
    Wong PCN (1966) Fracture epidemiology in a mixed Southeastern Asian community (Singapore). Clin Orthop 45:55–61Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • E. Harju
    • 1
  • E. Sotaniemi
    • 2
  • J. Puranent
    • 1
  • R. Lahti
    • 3
  1. 1.Departments of SurgeryUniversity of OuluOuluFinland
  2. 2.Department of MedicineUniversity of OuluOuluFinland
  3. 3.Department of RadiologyUniversity of OuluOuluFinland

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