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Vitamin D status and complications, readmissions, and mortality after hip fracture

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Abstract

Summary

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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Data availability

The database is available on request from the last author (ffrihagen@gmail.com).

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Acknowledgments

Elise Berg Vesterhus, Oslo University Hospital, for database maintenance.

Funding

Oslo University Hospital.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway

    F. Ingstad, L. B. Solberg, L. Nordsletten & I. Hestnes

  2. University of Copenhagen, Copenhagen, Denmark

    F. Ingstad

  3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    L. Nordsletten & F. Frihagen

  4. Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway

    P. M. Thorsby

  5. Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway

    F. Frihagen

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  1. F. Ingstad
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Corresponding author

Correspondence to F. Ingstad.

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None.

Ethics approval

The hip fracture register and data collection were approved by the Hospital Data Protection Officer (2014/12309) and Regional Ethics Committee South Eastern Norway (2014/1433).

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Preapproved waiver for quality audit Hospital Data Protection Officer (PVO 2014/12309, PVO 2015/18831, and PVO 2020/11011) and Regional Ethics Committee South Eastern Norway (2014/1433).

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Preapproved waiver for quality audit Hospital Data Protection Officer (PVO 2014/12309, PVO 2015/18831, and PVO 2020/11011) and Regional Ethics Committee South Eastern Norway (2014/1433).

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Ingstad, F., Solberg, L.B., Nordsletten, L. et al. Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporos Int 32, 873–881 (2021). https://doi.org/10.1007/s00198-020-05739-9

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