Hypovitaminosis D Among Patients Admitted With Hip Fracture to a Level-1 Trauma Center in the Sunny Upper Egypt

Abstract

Introduction:Despite abundant sunshine, hypovitaminosis D is common in the Middle East. The aim of this study was to determine the prevalence of hypovitaminosis D and related correlates among patients with hip fracture in Assiut University Hospitals in Upper Egypt.Materials and Methods:A cross-sectional study was carried out in 133 patients with hip fracture, aged 50 years and older, admitted to Trauma Unit of Assiut University Hospitals, from January through December 2014. Patients were selected by systematic random sampling. Serum 25-hydroxy vitamin D level was measured by enzyme-linked immunosorbent assay; bone mineral density (BMD) by dual-energy X-ray absorptiometry. Weight and height measurements were used for body mass index (BMI) calculation.Results:Patients’ median age was 70 years (range: 50-99); 51.9% were females. Osteoporosis (femoral neck T score: <−2.5 standard deviation) prevalence was 72.2%. Of all patients, 60.9% had vitamin D deficiency (<20 ng/mL); 15.8% reported vitamin D inadequacy (from 20 to 29 ng/mL) and vitamin D levels were normal in 23.3% (>30 ng/mL). According to univariate analysis, vitamin D deficiency was significantly associated with obesity (P = .012) and low T scores of the femoral neck (P = .001), L2 (P = .021), L3 (P = .031), L4 (P = .012), and the greater trochanter (P < .001). In a multivariable logistic regression model, high BMI and low BMD of the femoral neck and greater trochanter were associated with hypovitaminosis D.Conclusion:Prevalence of hypovitaminosis D is high among patients with hip fracture and associated with low BMD and high BMI. Increasing awareness about prevention as well as detection and treatment of vitamin D deficiency is recommended.

Hypovitaminosis D in the Greek Elderly Population Doesn't Concern Only Patients with Hip Fracture

“…However, inadequate VD levels are a common condition among the elderly irrespective of their age and, therefore, all seniors should be investigated for possible VD deficiency and treated appropriately. In recent studies, the correlation between VD deficiency and age was significant only in patients over 70 years of age [13] while other studies found a significant association between bone loss and low 25 (OH) D levels in subjects over the age of 75 years old [30].…”

“…The literature concerning the hypovitaminosis D (<25 ng/ml) varies a lot. Thus, vitamin D deficiency was found in 65% of patients with a hip fracture in Russia, 67% in Italy, 57.5% in Egypt, 76.7 in Singapore, and 90% in Japan [13]. Surprising, our results are even worse than those previously reported in other countries since VD deficiency with the definition of 25 ng/ml was present in 95.1% of those aged> 65 years with a hip fracture and in 63.3% of the elderly population with degenerative disease.…”

Energy, Waves, and Forces in Bilateral Fracture of the Femoral Necks: Two Case Presentations and Updated Critical Review

“…Powell in 1960 was focused on femoral neck fractures occurring mainly through contractions following electroconvulsive therapy. Hormone activity [ 24 , 41 ], metabolic diseases affecting the bones, and deficiencies in vitamin D or calcium [ 20 , 42 ], were not investigated. Since the 1960s, medical research has evolved tremendously within all branches, including in orthopedics, traumatology, metabolic diseases, and others.…”

“…The strongest sources for such an enhanced frailty of the bone are presumably her metabolic diseases (see also refs. [ 5 , 10 , 11 , 12 , 13 , 14 , 20 , 21 , 22 , 23 ]).…”

“…The latter can include high energy trauma [ 19 ]. However, a thorough investigation of the possible mechanisms leading to bilateral fracture of the femoral neck should bring to the fore questions related to wave propagation through various segments of the body [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”