Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing

Created November 2019

The prevalence of vitamin D deficiency in patients admitted with low trauma fractures - is pragmatic vitamin D supplementation appropriate?

Endocrine Abstracts (2019) 65 P88 | DOI: 10.1530/endoabs.65.P88

Presented at Society for Endocrinology BES 2019, Brighton, UK, 11 - 13 Nov 2019

Emma Eldridge, Sherwin Criseno, Mayla Buensalido & Neil Gittoes

1. Falls and Fractures category contains the following {include} --- 1. Tests for Vitamin D contains the following overview/opinion {include} --- * Overview Loading of vitamin D * Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013 * Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017 * Hip fracture 58 percent more likely if low vitamin D – meta-analysis March 2017 * Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014 * many more studies since then, but gave up counting * 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017 Items in both categories Loading and Testing are listed here: {category}

Aim: This study evaluated the prevalence of vitamin D deficiency in patients admitted with low trauma fracture (LTF). We also explored whether there was a rationale to offer appropriate and safe high dose vitamin D supplementation on admission for patients who are not already on vitamin D supplementation to avoid delay in commencing active bone protection treatment if required.

Patients and methods: Using the FLS database, 1460 patients over the age of 50 years seen and assessed during their in-patient admission between January 2015 and December 2017 were identified. Data on serum vitamin D level were collected and analysed.

Results: Of the 1460 inpatients seen by the FLS team, data on vitamin D results from 831 patients were included in the analysis. 629 patients were excluded as 331 did not have their vitamin D levels checked and 298 patients were already on vitamin D supplementation on admission. From the 831 patients, 68% (n=558) were female and 32% (n=273) were males.

Using the National Osteoporosis Society classification,

19% of patients were vitamin D replete (serum vitamin D level of >50 nmol/l),
24% were vitamin D insufficient (serum vitamin D level of 31–50 nmol/l) and
57% were vitamin D deficient (serum vitamin D level of < 30 nmol/l).

Subgroup analysis showed that vitamin D deficiency is highly prevalent amongst patients of 60 years and over and those admitted with fractured neck of femur.

Conclusion: This study highlights the high prevalence of vitamin D deficiency in patients admitted with LTF. This finding raises the potential benefit of a pragmatic approach of offering this group of patients with reasonable and adequate loading dose of vitamin D without the need for testing . A follow up study to determine whether this regimen actually renders patients replete with vitamin D is now needed.