Calcium and Vitamin D Supplementation in Osteoporosis and Fragility Hip Fracture Patients: A Retrospective NHANES Study

Abstract

Adequate vitamin D and calcium supplementation therapy in osteoporosis reduces the risk of fragility fractures and correlates with improved mortality outcomes in postoperative fragility hip fracture patients. However, the prevalence of adequate supplementation in this population remains unclear. Our purpose was to describe supplement use among the adult population in United States who have been told they had osteoporosis and identify factors associated with adequate supplementation, particularly in patients with history of hip fracture. The study sample comprised a total of 15,968 respondents from the National Health and Examinations Survey (NHANES 2007–2010, 2013–2014); 1,065 self-reported a diagnosis of osteoporosis and 266 self-reported a history of hip fracture. Additional patient factors were analyzed by multivariable logistic regression to assess associated factors of adequate vitamin D (≥ 600 international unit [IU]/day) and calcium (≥ 1000 mg/day) supplementation. The prevalence of vitamin D and calcium supplementation was significantly higher in the osteoporosis group than without (p = 0.001). However, supplemental intake reached adequate levels (≥ 600 IU/day of vitamin D and ≥ 1000mg/day of calcium) in only 28.8% of individuals with osteoporosis for vitamin D, 51.6% for calcium, and 19.2% for both. Of individuals with additional history of hip fracture, only 14% reported adequate intake of both nutrients. Female sex (odds ratio [OR]: 2.35, p < 0.001), older age (OR: 1.02, p < 0.001), and Caucasian race (OR: 1.456, p = 0.004) were positive factors of adequate supplementation, while Hispanic ethnicity was a negative factor (OR: 0.658, p = 0.009). Unexpectedly, a history of hip fracture did not affect the odds of adequate treatment (OR: 0.685, p = 0.176). Adults with known osteoporosis in the United States are self-reporting inadequate supplementation therapy, and significant gender and racial disparities exist. There is a broad need for improved supplementation to help manage this disease, particularly among adults with prior hip fracture, a vulnerable population most relevant for orthopaedic surgeons. This study serves as a call-to-action for orthopaedic surgeons to ensure their fragility hip fracture patients receive adequate supplementation postoperatively to maximize their health and recovery. This was a Level III, retrospective cohort study.