Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture

Abstract

The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. Objectives: (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2–13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6–39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.

Low serum levels of vitamin D significantly increase the risk of death in older adults with hip fractures: a prospective cohort

“…Other authors have also found associations between 25(OH)D 3 levels and mortality. Toldy et al 19 , in a case-control study, had results similar to ours. Fisher et al 21 , in multivariate analyses, found seven variables that independently increased in-hospital mortality among patients treated for hip fracture, including serum 25(OH)D 3 levels below 25nmol/L.…”

“…Considering that our state is geographically located close to the 30 th South parallel and the ethnic makeup of the southern Brazilian population is overwhelmingly white (>80%) 22 , studies assessing the effects of serum 25(OH)D 3 levels in patients with hip fractures are necessary. Our sample is similar to those previously reported in the literature in terms of age and sex 18 , 19 .…”

Preoperative Vitamin D Deficiency is Associated with Increased One-Year Mortality in Chinese Geriatric Hip Fracture Patients – A Propensity Score Matching Study

“… 17 , 18 Survival analysis indicated that the t-25OHD showed a tendency to predict survival, as the one-year mortality rate increased from 8% to 14% when comparing the t-25OHD deficiency group (≤16 ng/mL) and the control group. 14 In addition, a retrospective, total cohort study including 30,552 patients found that Vitamin D supplementation showed a moderate but significant influence on postoperative mortality in hip fracture patients, 29 which is in favor of our findings. However, the opposite side claimed that the four groups classified by quartiles of serum 25(OH)D did not differ in the one-year mortality of geriatric hip fracture patients.…”

“…Currently, there is no consensus on the optimal cut-off values of t-25OHD for predicting clinical outcomes and the definition of adequate vitamin D status due to the different racial background. 14 , 34 Based on the results of an observational, cross-sectional analysis, which was conducted in healthy South Asian populations who were aged from 40 to 69 years, 92% of the patients (5918 in 6433) were classified as Vitamin D deficiency (<20 ng/mL) according to the criteria, which were primarily set based on Caucasian populations. 35 Consistently, we also found that the best cut-off values (16.21 ng/mL before PSM and 17.80 ng/mL after PSM) for predicting one-year mortality in south Chinese geriatric hip fracture patients were slightly lower than the commonly used cut-off thresholds of Vitamin D deficiency.…”

“…The independent variable in our study was the preoperative total serum Vitamin D level. Serum total 25-hydroxy-VD (t-25OHD) is currently the most widely used indicator of Vitamin D status, 14 and Vitamin D deficiency was defined as <20ng/mL. 9 Serum t-25OHD level was quantified by an electrochemiluminescence kit (Vitamin D total, Roche Diagnostics GmbH, Mannheim, Germany).…”