Positive Effects of a Sufficient Pre-fracture Serum Vitamin D Level on the Long-Term Survival of Hip Fracture Patients in Finland: A Minimum 11-Year Follow-Up
Several studies have shown that the mortality of elderly hip fracture patients is higher than that in the general population, and is higher in male than in female hip fracture patients.
The objective of this study was to investigate factors affecting overall mortality at a minimum of 11 years following a new hip fracture.
The sex, age, pre-fracture serum 25-hydroxyvitamin D level, American Society of Anesthesiologists physical status classification (ASA class), 1- to 12-month mortality, and 2- to 11-year mortality of hip fracture patients were collected. The use of anti-osteoporotic medication and prescribed calcium and vitamin D supplements during the first 3 post-operative years were checked. The survival of the patients was analyzed using both the Bayesian multivariate analysis and the life table method.
The mean age of females at the time of the index hip fracture was 80.5 years and of males was 73 years. The protective factors were age <80 years; ASA class 1–2; serum 25-hydroxyvitamin level ≥50 nmol/L; post-fracture use of calcium and vitamin D supplementation; post-fracture concomitant use of calcium and vitamin D supplementation and anti-osteoporotic drugs; and male sex. The excess mortality was higher among women than men. Survival was highest among patients with a vitamin D level of ≥50 nmol/L. Post-fracture concomitant use of calcium and vitamin D and anti-osteoporotic drugs was positively associated with survival.
Our results indicate a positive relationship between a sufficient pre-fracture vitamin D serum concentration (≥50 nmol/L) and survival, and a potential relationship between reduced mortality and the concomitant post-fracture use of prescribed calcium plus vitamin D supplementation and anti-osteoporotic medication.
KeywordsExcess Mortality Fracture Liaison Service Anesthesiologist Physical Status Classification Prescribe Calcium Severe Hypovitaminosis
This manuscript was written and edited by the authors, who take full responsibility for its content.
Compliance with ethical standards
The study was supported by grants from the EVO foundation of the Kymenlaakso and Päijät-Häme healthcare districts. The authors have no conflicts of interest that are directly relevant to the content of this study.
- 27.Nurmi-Lüthje I, Lüthje P, Kaukonen JP, et al. Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis. Drugs Aging. 2009;26:409–21.PubMedCrossRefGoogle Scholar
- 30.Tsuboi M, Hasegawa Y, Suzuki S, et al. Mortality and mobility after hip fracture in Japan: a ten-year follow-up. J Bone Joint Surg Br. 2007;89-B:461–6.Google Scholar
- 44.The National FINDIET 2012 Survey. National Institute for Health and Welfare. Report 16/2013. http://urn.fi/URN:ISBN:978-952-245-951-0. Accessed 24 Apr 2015.
- 45.Cameron ID, Chen JS, March LM, et al. Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res. 2010;4:866–72.Google Scholar
- 50.Huntjens KM, van Geel TA, van den Bergh JP, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014;96(4):e29. doi: 10.2106/JBJS.L.00223.
- 52.National guidelines. Treatment of hip fracture patients. Duodecim. 2006;122:358–379. http://www.kaypahoito.fi. Accessed 13 Sep 2010.