Give Vitamin D to all fracture patients – cost effective to prevent nonunions

Created November 2016

Economic Benefit of Calcium and Vitamin D Supplementation: Does It Outweigh the Cost of Nonunions?

Journal of Orthopaedic Trauma:, Aug 2016 - Vol 30 - Issue 8 - p e285–e288, doi: 10.1097/BOT.0000000000000592

Childs, Benjamin R. BS; Andres, Brendan A.; Vallier, Heather A. MD

Propose 1,600 IU of vitamin D and 1,200 mg of Calcium for only 8 weeks     other studies have found that more is needed along with a loading dose Propose to give the $8 worth of supplements to ALL fracture patients     $8 cost does not include education, distribution They anticipate it would reduce nounions by 5% Nonunions rate is ~4%, Cost of nonunion ~$17,000     $17,000 does not include loss of job income, suffering, or malpractice Number needed to treat = 1000     (1 in 25 fractures are nonion, expect 1 in 20 nonunions will be prevented) VitaminDWiki speculates number needed to treat = 100 if use high dose and loading dose See also VitaminDWiki * Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013 * Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018 * UK patients given vitamin D for 3 months were 16 percent less likely to be readmitted – Sept 2016 * UK would save as least 636 million dollars annually by giving 800 IU vitamin D free to all seniors – June 2014 * Prevent the fracture from occuring in the first place * Bone fractures in children requiring surgery were 55X more likely with low vitamin D – June 2015 * Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012 * The Calcium recommended in this paper is probably not needed * Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014 * Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010 * Overview Fractures and vitamin D * Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016 * Cost savings with Vitamin D **category listing has items along with related searches** * Nonunion after elective foot or ankle reconstruction 8 times more likely if low vitamin D – May 2017 * Trauma with fracture – 2 weeks longer hospital stay if less than 10 ng vitamin D – Jan 2018

Objectives: The purpose was to evaluate economic benefit of calcium and vitamin D supplementation in orthopaedic trauma patients. We hypothesized that reduced nonunion rates could justify the cost of supplementing every orthopaedic trauma patient.

Design: Retrospective, economic model.

Setting: Level 1 trauma center.

Patients/Participants: Adult patients over 3 consecutive years presenting with acute fracture.

Intervention: Operative or nonoperative fracture management.

Main Outcome Measurements: Electronic medical records were queried for ICD-9 code for diagnosis of nonunion and for treatment records of nonunion for fractures initially treated within our institution.

Results: In our hospital, a mean of 92 (3.9%) fractures develop nonunion annually. A 5% reduction in nonunion risk from 8 weeks of vitamin D supplementation would result in 4.6 fewer nonunions per year. The mean estimate of cost for nonunion care is $16,941. Thus, the projected reduction in nonunions after supplementation with vitamin D and calcium would save $78,030 in treatment costs per year. The resulting savings outweigh the $12,164 cost of supplementing all fracture patients during the first 8 weeks of fracture healing resulting in a net savings of $65,866 per year.

Conclusions: Vitamin D and calcium supplementation of orthopaedic trauma patients for 8 weeks after fracture seems to be cost effective. Supplementation may also reduce the number of subsequent fractures, enhance muscular strength, improve balance in the elderly, elevate mood leading to higher functional outcome scores, and diminish hospital tort liability by reducing the number of nonunions.

Level of Evidence: Economic Level V. See Instructions for Authors for a complete description of levels of evidence.

Tags: Cost savings Falls and Fractures