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Elevated Serum PTH Is Independently Associated with Poor Outcomes in Older Patients with Hip Fracture and Vitamin D Inadequacy

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Abstract

To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 ± 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5–1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03–1.15, P = 0.002), prolonged length of stay (LOS ≥ 20 days; OR = 1.05, 95% CI 1.01–1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01–1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS ≥ 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS ≥ 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.

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Authors and Affiliations

  1. Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia

    A. Fisher, W. Srikusalanukul & M. Davis

  2. Australian National University Medical School, Canberra, ACT, Australia

    A. Fisher, S. Goh, W. Srikusalanukul & M. Davis

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  1. A. Fisher
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  2. S. Goh
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Correspondence to A. Fisher.

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Fisher, A., Goh, S., Srikusalanukul, W. et al. Elevated Serum PTH Is Independently Associated with Poor Outcomes in Older Patients with Hip Fracture and Vitamin D Inadequacy. Calcif Tissue Int 85, 301–309 (2009). https://doi.org/10.1007/s00223-009-9283-1

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