Hospital found that Vitamin D saves money by improving bone fracture healing

Created March 2016

Economic benefit of calcium and vitamin D supplementation: Does it outweigh the cost of nonunions?

J Orthop Trauma. 2016 Mar 21. [Epub ahead of print]

Childs BR1, Andres BA, Vallier HA.

1Study performed at: Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA, affiliated with Case Western Reserve University.

Normally 4% of fractures do not fuse $17,000 extra for non-fusing $12,000 to give Vitamin D and Calcium to EVERY fracture patient (2875?) for 8 weeks Net savings to hospital $68,500/year (for just a tiny 5% improvement in rate of bone fusing) Abstract fails to mention dose size VitaminDWiki expects far more improvement and cost effectiveness if they did any of the following: 1. Started with a loading dose – so not have to wait almost 8 weeks for vitamin levels to improve 1. Also applied Vitamin D topically to the skin near the fracture 1. Increased the dose size for people at high risk of vitamin D deficiency, rather than “one size fits all” 1. Added the Silicon, Magnesium, Vitamin K and protein- which are also needed to build bones 1. Perhaps add vitamin D directly to the bone during surgery * Bone implants aided by Vitamin D in 80 percent of studies, conclusion – more studies needed – Feb 2016 See also VitaminDWiki * Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014 * Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018 * Fractures reduced with any amount of vitamin D and some Calcium - Cochraine April 2014 * Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010 * Note: Many fractures can be PREVENTED by adding Vitamin D/UV/Sun * Hypothesis: increased bone mineral density needs protein, Ca, Mg, Vitamin D and K * Healthy bones need: Calcium, Vitamin D, Magnesium, Silicon, Vitamin K, and Boron – 2012 * Total hip replacement: 14 times more likely to redo if low vitamin D – March 2017 * Nonunion after elective foot or ankle reconstruction 8 times more likely if low vitamin D – May 2017 * Bone - Health **category listing has items along with related searches**

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 eight 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 outweighs 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 appears 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.

PMID: 27010185