Importance of vitamin D in hospital-based fracture care pathways

Abstract

Objectives-This project was developed to identify ways to support hospital-based improvements for the identification and management of osteoporosis following treament of a fragility fracture.Design-This is a retrospective review of medical records of sets of consecutive patients who were admitted for surgical treatment of fragility fracture following introduction of several versions of admission and discharge care pathways. Effectiveness of the admission pathway was defined as % subjects with measurement of serum 25-hydroxyvitamin D (25(OH)D) during hospitalization; effectiveness of the discharge pathway was defined as % subjects with documentation of instructions for calcium and/or vitamin D supplementation.Setting-This study reviewed medical records of patients admitted to hospital for surgical treatment of a fragility fracture.Participants-Medical records were evaluated for 98 patients older than 50-years who were admitted with a fragility fracture of the hip or femur. Conclusion-The high prevalence of vitamin D insufficiency (78%) observed in this study affirms the importance of incorporating vitamin D supplementation in hospital-based fracture care pathways. The discharge pathway was more effective than the newer admission pathway, a finding attributable to effects of familiarity, retraining, and introduction of computer-prompts. These evolving pathways represent a much-needed paradigm shift in the care of fragility fracture patients. Measurements-Medical

Getting hip to vitamin D: A hospitalist project for improving the assessment and treatment of vitamin D deficiency in elderly patients with hip fracture

“…The percentage of hip fracture patients screened for vitamin D deficiency showed significant improvement after our interventions, rising to 93.5%. As a comparison with our results, a 2008 study after implementation of a hip fracture pathway reported only screening 37% of patients for vitamin D deficiency . The main barrier we identified was occasional failure to use the electronic order set.…”

Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures

“…Extremely low vitamin D levels are common in hip fracture patients and they may lead to impaired lower extremity functional recovery and increased falls. We have put in place hip fracture care pathways at Brigham and Women's Hospital and the University of Maryland to transform the clinical care of patients with hip fractures [36,37]. A limitation of our study is that, because only a small fraction of women with a hip fracture had a 25(OH)D level that was in the "sufficient range" (greater than 80 nmol/L or 32 ng/mL), we could not assess changes in functional performance over a wide range of 25(OH)D levels.…”

Vitamin D insufficiency and deficiency in patients with fractures of the fifth metatarsal

“…Iglar and Hogan reviewed 31 studies linking hypovitaminosis D to complications such as increased risk of graft failure in renal patients [15], wound breakdown and infection [16,17], and organ transplant rejection [18,19]. In cases specific to orthopaedic practice, suboptimal vitamin D levels have been linked to refracture following surgical fixation of 5th metatarsal fractures [20], and there is evidence to support giving vitamin D supplementation to elderly patients with fractures of the hip [21,22] and proximal humerus [23].…”