What Is the Role of Vitamin D Supplementation in Acute Fracture Patients? A Systematic Review and Meta-Analysis of the Prevalence of Hypovitaminosis D and Supplementation Efficacy

Sprague, Sheila; Petrisor, Brad; Scott, Taryn; Devji, Tahira; Phillips, Mark; Spurr, Hayley; Bhandari, Mohit; Slobogean, Gerard P.

doi:10.1097/bot.0000000000000455

Cited by 60 publications

(52 citation statements)

References 70 publications

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“…28,50 Micronutrient deficiencies are more likely to be observed in orthopedic trauma patients than protein malnutrition. For instance, 40-70% of elderly patients presenting with a fragility or trauma-induced fracture are vitamin D deficient, 51,52 which has been shown to increase the odds of developing a non-union (odds ratio, 1.14; 95% confidence interval, 1.05-1.22). 3 Vitamin D is important in regulating calcium homeostasis, both of which have critical roles in facilitating mineralization of the callus that requires the deposition of approximately 1.7-2.3 g of hydroxyapatite per cm 3 of bony callus.…”

Section: Impact Of Nutritional Deficiencies On Bone Healingmentioning

confidence: 99%

Advances and Promises of Nutritional Influences on Natural Bone Repair

Roberts

Drissi

2019

Journal Orthopaedic Research

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Impaired fracture healing continues to be a significant public health issue. This is more frequently observed in aging populations and patients with co‐morbidities that can directly influence bone repair. Tremendous progress has been made in the development of biologics to enhance and accelerate the healing process; however, side‐effects persist that can cause significant discomfort and tissue damage. This has been the impetus for the development of safe and natural strategies to hasten natural bone healing. Of the many possible approaches, nutrition represents a safe, affordable, and non‐invasive strategy to positively influence each phase of fracture repair. However, our understanding of how healing can be hindered by malnutrition or enhanced with nutritional supplementation has lagged behind the advancements in both surgical management and the knowledge of molecular and cellular drivers of skeletal fracture repair. This review serves to bridge this knowledge gap as well as define the importance of nutrition during fracture healing. The extant literature clearly indicates that pre‐existing nutritional deficiencies should be corrected, and nutritional status should be carefully monitored to prevent the development of malnutrition for the best possible healing outcome. It remains unclear, however, whether the provision of nutrients beyond sufficiency has any benefit on fracture repair and patient outcomes. The combined body of pre‐clinical studies using a variety of animal models suggests a promising role of nutrition as an adjuvant therapy to facilitate fracture repair, but extensive research is needed, specifically at the clinical level, to clarify the utility of nutritional interventions in orthopedics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:695‐707, 2020

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Section: Impact Of Nutritional Deficiencies On Bone Healingmentioning

confidence: 99%

Advances and Promises of Nutritional Influences on Natural Bone Repair

Roberts

Drissi

2019

Journal Orthopaedic Research

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“…Vitamin D deficiency is endemic worldwide, as it is in patients with a recent fracture 91. Vitamin D supplementation (800 IU/day), with adequate calcium intake, is associated with a 15%–20% reduction in non-vertebral fractures, and also with a 20% reduction in falls 92–95.…”

Section: Recommendationsmentioning

confidence: 99%

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

et al. 2016

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The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.

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“…Vitamin D is involved in each stage of the fracture healing process, and the overall effect on fracture healing has yet to be elucidated . A recent systematic review showed that more than 70% of fracture patients are reported to have serum 25‐hydroxy‐vitamin D (25(OH)D) levels <30 ng/ml during the acute fracture healing period . The clinical significance of these findings is unclear, but many surgeons believe low levels of vitamin D may be associated with impaired fracture healing …”

mentioning

confidence: 99%

“…11 A recent systematic review showed that more than 70% of fracture patients are reported to have serum 25-hydroxy-vitamin D (25 (OH)D) levels <30 ng/ml during the acute fracture healing period. 12 The clinical significance of these findings is unclear, 13 but many surgeons believe low levels of vitamin D may be associated with impaired fracture healing. 14 Literature assessing the effect of vitamin D deficiency on CTX and P1NP is limited, 3 and to our knowledge, no study has assessed the relationship of baseline serum 25(OH)D on CTX and P1NP during the fracture healing period.…”

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confidence: 99%

Serum 25(OH)D is associated with an altered bone turnover marker response after a hip fracture

Stewart

O’Hara

Orwig

et al. 2019

Journal Orthopaedic Research

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C‐terminal telopeptide of type I collagen (CTX) and procollagen type 1 N‐terminal propeptide (P1NP) are bone turnover markers (BTMs) that are promising surrogate measures of fracture healing; however, it is unknown if their response is affected by other bone healing metabolites. Since 70% of fracture patients are reported to have insufficient serum vitamin D, we sought to determine if serum 25(OH)D levels are associated with differential changes in CTX and P1NP concentrations after hip fracture. This prospective cohort included hip fracture patients 65 years of age or older admitted to one of eight Baltimore‐area hospitals. Serum samples were collected at baseline, 2‐, 6‐, and 12‐month post‐fracture. A mixed‐effects repeated‐measures analysis was used to determine the longitudinal association between vitamin D deficiency (25(OH)D < 20 ng/ml) and CTX and P1NP. Baseline lab values were obtained for 296 participants (mean age, 80.8 years; 51% male; 55% 25(OH)D < 20 ng/ml). During the acute fracture healing period P1NP concentrations increased by 14% (95%CI: 7–21%, p < 0.01) while CTX levels did not change (p = 0.07). Both CTX and P1NP decreased below baseline at 6 and 12 months. CTX levels were higher in participants with baseline 25(OH)D < 20 ng/ml (p = 0.01). There was no association between 25(OH)D < 20 ng/ml and P1NP levels over the study duration (p = 0.33). Data from this large, longitudinal cohort support claims that CTX and P1NP concentrations change during fracture healing; however, the differential response of CTX among vitamin D deficient patients highlights important questions for its utility as a reliable surrogate marker of fracture healing. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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What Is the Role of Vitamin D Supplementation in Acute Fracture Patients? A Systematic Review and Meta-Analysis of the Prevalence of Hypovitaminosis D and Supplementation Efficacy

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 60 publications

References 70 publications

Advances and Promises of Nutritional Influences on Natural Bone Repair

Advances and Promises of Nutritional Influences on Natural Bone Repair

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

Serum 25(OH)D is associated with an altered bone turnover marker response after a hip fracture

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