Risedronate significantly reduces the risk of hip fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density.

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SummaryObjectives To determine the prevalence of vitamin D deficiency in pregnant women and their neonates and to examine factors associated with vitamin D deficiency. Design and patients Population-based study of pregnant women and their neonates from South-eastern Sydney, Australia. Measurements Serum 25 hydroxy-vitamin D (25-OHD), PTH, calcium, albumin, phosphate and alkaline phosphatase were measured in women at 23-32 weeks gestation and on cord blood at delivery. Maternal skin phototype was recorded using the Fitzpatrick scale. Results Vitamin D deficiency (defined as 25-OHD ≤ 25 nmol/l) was found in 144 of 971 (15%) women and 98 of 901 (11%) neonates. Median 25-OHD was 52 nmol/l (range 17-174) in mothers and 60 nmol/l (17-245) in neonates. Maternal 25-OHD levels varied by season, with lowest levels in late winter/early spring ( P < 0·001). Factors associated with maternal vitamin D deficiency in multiple logistic regression were (OR, 95% CI): maternal birthplace outside Australia: 2·2 (1·4-3·5, P = 0·001), dark skin phototype: 2·7 (1·6-4·5, P < 0·001), wearing a veil: 21·7 (11·7-40·3, P < 0·001) and younger maternal age: 0·93 (0·89-0·97, P = 0·001). Maternal vitamin D deficiency increased the risk of neonatal vitamin D deficiency (OR 17·2, 95% CI 8·8-34·3) and birth weight was lower among infants of deficient vs. sufficient mothers: mean (SD) 3245 g (545) vs. 3453 g (555), P < 0·001. Conclusions Vitamin D deficiency is common among pregnant women; immigrant, veiled and dark skinned women are at greatest risk. Maternal vitamin D deficiency increases the risk of neonatal vitamin D deficiency and lower birth weight.

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Recurrent and injurious falls are common after hip fracture and are associated with multiple risk factors, many of which are treatable. Interventions should therefore be tailored to alleviating or reversing any nutritional, physiological, and psychosocial risk factors of individual patients.