Sub-optimal serum 25-hydroxyvitamin D level affects 2-year survival after hip fracture surgery

Cher, Eric Wei Liang; Allen, John C.; Moo, Ing How; Lo, Ean Chung; Peh, Bryan Ce Jie; Howe, Tet Sen; Koh, Joyce Suang Bee

doi:10.1007/s00774-019-01082-0

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…However, the corresponding mortality among patients with a level < 50 nmol/L was lower in the present study (27% vs. 42%, respectively). Two-year mortality in the level less than 75 nmol/L was also slightly higher (13.5%) in the present study than was found in Singapore (11%) [ 36 ].…”

Section: Discussioncontrasting

confidence: 51%

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Relatively low and moderate pre-fracture serum 25-hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland: a minimum 3-year follow-up

Nurmi-Lüthje

Tiihonen

et al. 2021

Osteoporos Int

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Summary The association between serum 25-hydroxyvitamin D level and post-fracture mortality indicates beneficial relatively high serum 25-hydroxyvitamin D concentrations. A 1-year cohort study on 245 hip fracture patients in Finland indicated the lowest 3-year mortality and highest survival among patients with serum 25-hydroxyvitamin D level of 50–74 nmol/L. Purpose To explore pre-fracture serum 25-hydroxyvitamin D level as a factor associated with post-fracture survival among a cohort of hip fracture patients in Finland. Methods A prospectively collected cohort of hip fracture patients ( n = 245, 70% women) from two hospitals was followed for 3.2 post-hip fracture years. Serum 25-hydroxyvitamin D was measured in admission to the hospital and classified: < 50, 50–74, 75–99, and ≥ 100 nmol/L. Survival was analyzed with a Bayesian multivariate model. Relative survival was explored with the life table method according to serum 25-hydroxyvitamin D. Mortality according to serum 25-hydroxyvitamin D level and to the hospital was calculated. Results Mortality in the patients with serum 25-hydroxyvitamin D level of 50–74 nmol/L was significantly lower than in all other patients together at every post-fracture year. The most important factors for survival were age under 85 years; living in an actual/private home; serum 25-hydroxyvitamin D level of 50–74 nmol/L, followed by 75–99 nmol/L; ASA classes 1–2 and 3; and female sex. The mean age of patients with serum 25-hydroxyvitamin D level of 50–99 nmol/L was significantly higher than in other levels. Relative survival was highest in men, women, and patients in hospital B with serum 25-hydroxyvitamin D level of 50–74 nmol. Conclusion The highest 3-year survival and the lowest mortality in this cohort appeared in patients with pre-fracture serum 25-hydroxyvitamin D level of 50–74 nmol/L. This result differs from similar studies and is lower than the recommended level of 25-hydroxyvitamin D among hip fracture patients. The results should be examined in future research with larger data. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-021-06094-z.

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Section: Discussioncontrasting

confidence: 51%

“…In a very recent retrospective study from Singapore, 90% of 801 hip fracture patients (mean age 77.7 years) had a baseline serum 25-hydroxyvitamin D level of less than75 nmol/L, and their 2-year mortality was 11.0% [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Relatively low and moderate pre-fracture serum 25-hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland: a minimum 3-year follow-up

Nurmi-Lüthje

Tiihonen

et al. 2021

Osteoporos Int

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“…No relevant unpublished studies have been published to date. Ultimately, a total of nine studies were included in the meta‐analysis 7,15–22 …”

Section: Resultsmentioning

confidence: 99%

Impact of vitamin D deficiency on mortality in patients with hip fracture: A meta‐analysis

Llombart,

Mariscal,

Barrios

et al. 2023

J American Geriatrics Society

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BackgroundVitamin D deficiency has been linked to numerous health issues, including an increased risk of hip fractures. This meta‐analysis aimed to investigate the relationship between vitamin D deficiency and mortality in patients with hip fracture. To assess the impact of different levels of vitamin D deficiency on mortality in patients with hip fractures and examine the influence of potential confounding factors.MethodsA systematic search of PubMed, EMBASE, Scopus, and Cochrane Collaboration Library was conducted, resulting in nine eligible cohort studies (n = 4409). Patients with hip fractures were categorized based on their vitamin D levels as severe, moderate, or insufficient. Mortality was the primary outcome measure in this study. Subgroup analyses were performed according to the follow‐up time. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random‐effects model in Review Manager 5.4.ResultsNine studies, with a pool of 4409 patients, were included. Vitamin D insufficiency was significantly associated with increased mortality (OR 1.24, 95% CI 1.05–1.46; I2 = 4%). Severe deficiency also led to a significant increase in mortality (OR 2.08, 95% CI 1.09–3.97; I2 = 42%), whereas moderate deficiency did not show a significant effect (OR 1.06, 95% CI 0.79–1.44; I2 = 0%). Subgroup analysis revealed significant associations between vitamin D insufficiency and increased mortality at 1‐year (OR 1.37, 95% CI 1.06–1.77) and 2‐year follow‐ups (OR 1.78, 95% CI 1.01–3.15). After adjusting for potential confounders, no significant increase in the mortality rate was observed.ConclusionsThis meta‐analysis suggests that vitamin D insufficiency and severe deficiency are associated with increased mortality in patients with hip fracture. However, after adjusting for confounding factors, this association was not statistically significant. Further research is necessary to understand the role of vitamin D deficiency in this population.

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“…Indeed, in a recent study among 290 hip fracture patients, those with a vitamin D deficiency (25(OH)D < 25 nmol/l; 12%) had a reduced mobility at 60 days after the fracture [ 14 ]. In another study in Singapore among 801 hip fracture patients, 25(OH)D insufficiency and/or deficiency affecting about 92% of patients was a significant predictor of mortality at 2 years but not at 90 days [ 41 ]. Despite severe vitamin D deficiency below 30 nmol/l being present in the majority of hip fracture patient, only 10% of hip fracture patients had any vitamin D supplementation on admission [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…2). Many studies in patients with hip fractures and an average age of around 80 years and over have reported a prevalence of serum 25(OH)D below 50 nmol/l ranging between 34 and 80%, even if mean values are around 40 to 50 nmol/l [12,14,[40][41][42][43][44][45][46][47][48] (Table 1). A high prevalence of vitamin D deficiency was also observed among 219 orthopedic patients presenting with vertebral fragility fractures [49] as well as among 93 patients with pelvic insufficiency fractures [50].…”

Section: Prevalence Of Vitamin D Deficiency In Patients With Osteoporotic Fracturesmentioning

confidence: 99%

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

et al. 2021

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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.

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Sub-optimal serum 25-hydroxyvitamin D level affects 2-year survival after hip fracture surgery

Cited by 8 publications

References 35 publications

Relatively low and moderate pre-fracture serum 25-hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland: a minimum 3-year follow-up

Relatively low and moderate pre-fracture serum 25-hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland: a minimum 3-year follow-up

Impact of vitamin D deficiency on mortality in patients with hip fracture: A meta‐analysis

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

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