Adjuvant Vitamin D Injection in Elderly Patients Before Intertrochanteric Fracture Surgery: A Randomised Controlled Trial

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2024 Mar 18

PMID 38495917

Authors

Mehrdad Rabiee Rad

Ghazal Ghasempour Dabaghi

Alireza Afshari Safavi

Pooya Moshkdar

Hossein Akbariaghdam

Affiliations

Soon will be listed here.

Abstract

Background: There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery.

Methods: This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000 IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24 months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis.

Results: 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively ( = .71), 15% and 12.5% at 1-year ( = .83), and 25% and 27.5% at 2-year ( .98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups.

Conclusions: A single preoperative 300,000 IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level.

References

Mak J, Mason R, Klein L, Cameron I . An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial. BMC Musculoskelet Disord. 2016; 17:336. PMC: 4982117. DOI: 10.1186/s12891-016-1174-9. View

Cummings S, Melton L . Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359(9319):1761-7. DOI: 10.1016/S0140-6736(02)08657-9. View

Bischoff-Ferrari H, Bhasin S, Manson J . Preventing Fractures and Falls: A Limited Role for Calcium and Vitamin D Supplements?. JAMA. 2018; 319(15):1552-1553. DOI: 10.1001/jama.2018.4023. View

Mak J, Klein L, Finnegan T, Mason R, Cameron I . An initial loading-dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP). BMC Geriatr. 2014; 14:101. PMC: 4164764. DOI: 10.1186/1471-2318-14-101. View

Dahl E . Mortality and life expectancy after hip fractures. Acta Orthop Scand. 1980; 51(1):163-70. DOI: 10.3109/17453678008990781. View

Borges A, Torres J, Simao R, Trigo Cabral A, Pinto R . Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures. Acta Med Port. 2014; 27(2):218-22. DOI: 10.20344/amp.4280. View

Wang Y, Tao Y, HYMAN M, Li J, Chen Y . Osteoporosis in china. Osteoporos Int. 2009; 20(10):1651-62. DOI: 10.1007/s00198-009-0925-y. View

White B, Fisher W, Laurin C . Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987; 69(9):1335-40. View

Zhang H, Zhu X, Dong W, Wang Q . Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis. Ann Nutr Metab. 2018; 73(2):121-130. DOI: 10.1159/000490670. View

10.

Bischoff-Ferrari H, Giovannucci E, Willett W, Dietrich T, Dawson-Hughes B . Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006; 84(1):18-28. DOI: 10.1093/ajcn/84.1.18. View

11.

Kahwati L, Weber R, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M . Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018; 319(15):1600-1612. DOI: 10.1001/jama.2017.21640. View

12.

Ahn J, Bernstein J . Fractures in brief: intertrochanteric hip fractures. Clin Orthop Relat Res. 2010; 468(5):1450-2. PMC: 2853662. DOI: 10.1007/s11999-010-1263-2. View

13.

Kesmezacar H, Ayhan E, Unlu M, Seker A, Karaca S . Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 2009; 68(1):153-8. DOI: 10.1097/TA.0b013e31819adc50. View

14.

Kanis J, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby A . The components of excess mortality after hip fracture. Bone. 2003; 32(5):468-73. DOI: 10.1016/s8756-3282(03)00061-9. View

15.

Watts N, Manson J . Osteoporosis and Fracture Risk Evaluation and Management: Shared Decision Making in Clinical Practice. JAMA. 2016; 317(3):253-254. DOI: 10.1001/jama.2016.19087. View

16.

Hori K, Siu A, Nguyen E, Andrews S, Choi S, Ahn H . Osteoporotic hip fracture mortality and associated factors in Hawai'i. Arch Osteoporos. 2020; 15(1):183. DOI: 10.1007/s11657-020-00847-9. View

17.

Schulz K, Altman D, Moher D . CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c332. PMC: 2844940. DOI: 10.1136/bmj.c332. View

18.

Alexiou K, Roushias A, Varitimidis S, Malizos K . Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018; 13:143-150. PMC: 5790076. DOI: 10.2147/CIA.S150067. View

19.

Nasab S, Khorramdin E . The assessment of mortality and quality of life after intertrochanteric fracture of femur in patients older than 60 at Emam Khomeini Hospital of Ahvaz. Pak J Med Sci. 2017; 33(4):895-898. PMC: 5648960. DOI: 10.12669/pjms.334.13146. View

20.

Lee K, Lim J, Park Y, Ha Y . Erratum to: Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture. J Bone Metab. 2016; 23(1):49. PMC: 4791439. DOI: 10.11005/jbm.2016.23.1.49. View