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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

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Abstract

Background

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.

Objective

The objective of this study was to investigate factors affecting overall mortality at a minimum of 11 years following a new hip fracture.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Public Health, Hjelt Institute, University of Helsinki, PO Box 41, 00014, Helsinki, Finland

    Ilona Nurmi-Lüthje

  2. Department of Orthopaedics and Traumatology, North Kymi Hospital, Kuusankoski, Finland

    Peter Lüthje

  3. Department of Orthopaedics and Traumatology, Päijät-Häme Central Hospital, Lahti, Finland

    Juha-Pekka Kaukonen

  4. National Institute for Health and Welfare, Helsinki, Finland

    Matti Kataja

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  1. Ilona Nurmi-Lüthje
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Correspondence to Ilona Nurmi-Lüthje.

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Nurmi-Lüthje, I., Lüthje, P., Kaukonen, JP. et al. 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. Drugs Aging 32, 477–486 (2015). https://doi.org/10.1007/s40266-015-0267-8

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