How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

Abstract

In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.

Guidelines on the diagnosis and treatment of active Charcot neuro‐osteoarthropathy in persons with diabetes mellitus (IWGDF 2023)

“…Also, indirect evidence to support such supplementation is poor as studies in traumatic or fragility fractures are scarce. 102 We have therefore no information on the impact of low Vitamin D levels or poor calcium intake on the course of active CNO.…”

“…We could not identify intervention studies on possible beneficial effects of vitamin D and calcium supplementation in active CNO. Also, indirect evidence to support such supplementation is poor as studies in traumatic or fragility fractures are scarce 102 . We have therefore no information on the impact of low Vitamin D levels or poor calcium intake on the course of active CNO.…”

Sarcopenia and bone health: new acquisitions for a firm liaison

“…73 Specifically, vitamin D and calcium supplementation is known to improve BMD and muscle strength, and to reduce falls and fractures in adults deficient in these nutrients. 74 Furthermore, several observational studies have found a correlation between higher protein intake and higher retention of lean muscle mass and BMD in the elderly. 75,76 Creatine supplementation has also been observed to increase the benefits of endurance exercise in healthy individuals, although the effect in clinical populations with compromised muscle and bone health has yet to be determined.…”

Older adults and vitamin D hip fracture connections-what is the 2022 research base indicating?

“…However, it seems reasonable to suggest that some forms of hip fracture in older populations that are often not treated for possible osteoporotic risk 24 may derive some independent or collective benefit from vitamin D supplementation as far as reducing hip fracture incidence rates as well as mortality rates or further fractures post hip fracture surgery in vulnerable older adults. [24][25][26][27][28] In combination with silicon a recent basic study has revealed some degree of vitamin D influence on bone structure restoration and improved calcium absorption that appears to offer a possible avenue for enhancing bone related regeneration and that may prove valuable to examine further in the realm of hip fracture prevention and that is supported by human clinical evidence, [29][30][31][32] even though its presence may not impact number of falls or injurious falls that often lead to hip fractures. 33 However, there are multiple contrary study findings as well as multiple design problems that remain in this body of research, even though more favorable potentially relevant clinical findings prevail than not.…”