Abstract
Summary
In a cross-sectional study including 324 patients older than 65 years admitted to our hospital for osteoporotic hip fracture, we found that those patients with a more severe vitamin D deficiency had more severe osteoporotic hip fractures (Garden grades III–IV and Kyle III–IV).
Introduction
To identify possible differences in baseline characteristics of patients with different types of osteoporotic hip fracture.
Methods
Cross-sectional study including consecutive individuals over 65 admitted to our hospital for osteoporotic hip fracture over a year. Demographic data, fracture type, comorbidities, history of osteoporosis, functional capacity, nutritional status and vitamin D storage were evaluated.
Results
We included 324 patients (83 ± 7 years, 80% women). Two hundred sixteen patients (67%) had vitamin D deficiency (25OHD3 <25 ng/ml). In patients with severe femoral neck or intertrochanteric fractures (Garden III–IV and Kyle III–IV), vitamin D deficiency was more frequent (74%) and severe (25OHD3 20 ± 15 ng/ml) than in patients with less severe fractures (57%, 25OHD3 26 ± 21 ng/ml). Forty-three percent of patients had previous fractures. Only 15% of patients had been previously diagnosed with osteoporosis and 10% were receiving treatment. Patients receiving vitamin D supplements have higher 20OHD3 levels and less severe fractures.
Conclusions
Although vitamin D levels are not different between patients with intracapsular or extracapsular hip fractures, a more severe vitamin D deficiency seems to be associated to more severe osteoporotic hip fractures. A prior vitamin D supplementation could avoid a higher severity of these fractures.
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References
Eiskjaer S, Ostgård SE, Jakobsen BW et al (1992) Years of potential life lost after hip fracture among postmenopausal women. Acta Orthop Scand 63:293–296
Knobel H, Díez A, Arnau D, Alier A, Ibáñez J, Campodarve I, Supervía A, Nogués X (1992) The sequelae of osteoporotic femoral fracture in Barcelona. Med Clin (Barc) 98(12):441–444
Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307(6914):1248–1250
Pagès E, Cuxart A, Iborra J, Olona M, Bermejo B (1998) Factors associated with mortality and gait impairment in elderly patients with hip fractures. Med Clin (Barc) 110(18):687–691
Sosa Henríquez M, Segarra Sánchez MC, Limiñana Cañal JM, Hernández Hernández D, González Pacheco A, Betancor León P (1993) Morbidity and mortality of osteoporotic proximal femoral fracture after one year follow-up. Med Clin (Barc) 101(13):481–483
Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51(3):364–370
Zain Elabdien BS, Olerud S, Karlström G, Smedby B (1984) Rising incidence of hip fracture in Uppsala, 1965–1980. Acta Orthop Scand 55(3):284–289
Lawton JO, Baker MR, Dickson RA (1983) Femoral neck fractures—two populations. Lancet 2(8341):70–72
Cauley JA, Lui L-Y, Genant HK, Salamone L (2009) Risk factors for severity and type of the hip fracture. J Bone Miner Res 24:943–955
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL (2004) Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 425:64–71
Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 43:647–664
Kyle RF, Gustilo RB, Premer RF (1979) Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am 61(2):216–221
Levey AS et al (2000) A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 11:155A
Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65
Katz S et al (1963) Studies of illness in the aged. The index Of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919
Chapuy MC, Chapuy P, Meunier PJ (1987) Calcium and vitamin D supplements: effects on calcium metabolism in elderly people. Am J Clin Nutr 46(2):324–328
Quesada JM et al (1989) Vitamin D status of elderly people in Spain. Age Aging 18(6):392–397
Larrosa M et al (2001) Prevalence of hypovitaminosis D in elderly institutionalized residents: influence of a substitutive treatment. Med Clin (Barc) 117(16):611–614
Chapuy MC et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642
Martinez ME et al (1996) Vitamin D levels in patients with hip fracture in Madrid. Med Clin (Barc) 106(2):41–44
Baker MR et al (1979) Plasma 25-hydroxy vitamin D concentrations in patients with fractures of the femoral neck. Br Med J 1(6163):589
Glerup H et al (2000) Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 66(6):419–424
Kenzora JE et al (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56
Linton P (1944) On the different types of intrascapular fractures of the femoral neck. Acta Chir Scand suppl 86
Mannius S (1987) Incidence of hip fracture in western Sweden 1974–1982. Comparison of rural and urban populations. Acta Orthop Scand 58(1):38–42
Dias JJ, Robbins JA, Steingold RF, Donaldson LJ (1987) Subcapital vs intertrochanteric fracture of the neck of the femur: are there two distinct subpopulations? J R Coll Surg Edinb 32(5):303–305
Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD (1996) Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop Relat Res 330:166–72
Sahota O et al (2001) Hypovitaminosis D and ‘functional hypoparathyroidism’-the NoNoF (Nottingham Neck of Femur) study. Age Aging 30(6):467–472
Fisher A, Srikusalanukul W, Davis M, Smith P (2010) Hip fracture type: important role of parathyroid hormone (PTH) response to hypovitaminosis D. Bone 47:400–407
Fisher A, Goh S, Srikusalanukul W, Davis M (2009) Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcif Tissue Int 84:301–309
Sahota O et al (2004) The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 35(1):312–319
Peng EW, Elnikety S, Hatrick NC (2006) Preventing fragility hip fracture in high risk groups: an opportunity missed. Postgrad Med J 82(970):528–531
Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E (2005) Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg 125:503–505
Acknowledgments
We wish to thank to our statistician Mr. Joan Carles Oliva Morera, for his generous collaboration in the statistical data review of the manuscript.This work has been supported by a grant from the Catalan Society of Rheumatology and a grant from the Fundació Parc Taulí.
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Larrosa, M., Gomez, A., Casado, E. et al. Hypovitaminosis D as a risk factor of hip fracture severity. Osteoporos Int 23, 607–614 (2012). https://doi.org/10.1007/s00198-011-1588-z
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DOI: https://doi.org/10.1007/s00198-011-1588-z