Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

Abstract

ObjectiveTo assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture.MethodsConsecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated.ResultsEighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524–4.088; p = 0.469). Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180–2.191; p = 0.465).ConclusionSerum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.

Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture

“…[ 19 20 21 ] However, serum vitamin D concentrations and mortality rates in elderly patients with hip fractures are rarely reported. [ 22 23 ] Although our univariate analysis found that vitamin D deficiency was an independent risk factor for mortality after hip fracture, it was not associated with mortality after adjusting for age ( P <0.001), BMI ( P =0.041), type of management ( P <0.001), ASA score ( P =0.009), pre-fracture ambulatory status ( P <0.001), and osteoporosis ( P <0.001) in the multivariate analysis. This finding is similar to a previous study.…”

“…This finding is similar to a previous study. Gumieiro et al[ 22 ] assessed whether serum vitamin D concentration is associated with gait status and mortality among 87 elderly patients with fractures of the proximal femur 6 months after suffering the fracture. They reported that serum vitamin D concentration was not related to gait status or mortality among patients with fractures proximal femur.…”

“…They reported that serum vitamin D concentration was not related to gait status or mortality among patients with fractures proximal femur. [ 22 ] Madsen et al [ 23 ] performed a case control study of 562 patients aged ≥70 years with hip fractures and found that serum parathyroid hormone serum calcium levels were significantly associated with mortality, whereas serum 25-(OH)D level was not.…”

Elderly with proximal hip fracture present significantly lower levels of 25-hydroxyvitamin D

“…Browne et al, 13 using a different serum measuring unit (nmol/L) in a study in Ireland with 156 elderly patients with PFF, found that over 67% of their sample had insufficient or deficient 25(OH)D serum levels. Gumiero et al, 14 in a Brazilian study on gait in patients with PFF, also observed low levels of 25(OH)D, with a mean value of 27.8 ng/mL; 33.7% of the sample had deficient values, which differs from the findings of the present study 7, 14. Reduced serum levels of 25(OH)D were significantly related to PFF both in the present study and in previous studies; however, specific differences in serum levels of this vitamin are recognized by various authors, due to its relation to sun exposure and the genetic characteristics of the local population 11, 12, 13…”

“…In a review study, Patton et al reported that 25(OH)D levels were comparatively lower in women, regardless of the cut-off criteria used 6, 13, 14, 15, 16, 17, 18. Labronici et al, 18 when assessing post-menopausal women, found that 82% of the patients had 25(OH)D levels considered insufficient.…”