Analysis of Serum Vitamin D and Calcium Levels in Elderly Patients with Stable and Unstable Intertrochanteric Fractures: A Multi-center Prospective Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Nov 22

PMID 39576768

Authors

Kamran Alijanpour

Sina Afzal

Abolhasan Alijanpour

Hasan Barati

Hemmat Gholinia

Mehdi Tavassoli

Affiliations

Soon will be listed here.

Abstract

Background: Hip fractures are highly prevalent in the elderly, with intertrochanteric (IT) fractures of the femur constituting about half of the fractures in this region. We aimed to evaluate the levels of serum calcium and vitamin D in patients with stable or unstable IT fractures to study their contribution to the severity of IT fracture.

Materials And Methods: Using a prospective cross-sectional design, we enrolled patients with IT fractures admitted to two referral orthopedic centers in 2022. Unstable IT fracture was defined as those with reverse obliquity or a trans-trochanteric pattern of fracture, a large or comminuted posteromedial fragment, and subtrochanteric extension of the fracture. Serum 25 (OH) vitamin D and calcium levels were the main study variables assessed by lab tests and compared among the two study groups: stable and unstable IT fractures.

Results: A total of 286 patients with a mean age of 70.5 ± 7.3 years and a female predominance (60.4%) were included in the final analysis. Among the patients, 139 (48.6%) had stable IT fractures, and 147 (51.4%) had unstable IT fractures. The mean serum level of vitamin D was significantly higher in the stable group (30.3 ± 7.0) compared to the unstable group (26.5 ± 6.1) (P-value = 0.007). Increasing age was associated with a decreasing level of serum vitamin D; however, the association was weak and not statistically significant (P-value = 0.319). The mean serum calcium level was higher among stable cases (8.6 ± 0.7) compared to unstable cases (8.4 ± 0.9); however, the difference was not statistically significant (P-value = 0.540). Vitamin D and calcium levels were almost similar among males and females.

Conclusion: Lower levels of serum vitamin D were significantly associated with unstable IT fractures, and supplementation with this element might prevent severe fractures of this type and other fragility hip fractures.

References

Li P, Lin Z, Pang Z, Zeng Y . Does serum calcium relate to different types of hip fracture? A retrospective study. Chin J Traumatol. 2016; 19(5):275-277. PMC: 5068212. DOI: 10.1016/j.cjtee.2016.06.003. View

Maharlouei N, Khodayari M, Forouzan F, Rezaianzadeh A, Lankarani K . The incidence rate of hip fracture in Shiraz, Iran during 2008-2010. Arch Osteoporos. 2014; 9:165. DOI: 10.1007/s11657-013-0165-9. View

Adeyemi A, Delhougne G . Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JB JS Open Access. 2019; 4(1):e0045. PMC: 6510469. DOI: 10.2106/JBJS.OA.18.00045. View

Babhulkar S . Unstable trochanteric fractures: Issues and avoiding pitfalls. Injury. 2017; 48(4):803-818. DOI: 10.1016/j.injury.2017.02.022. View

Rapp K, Buchele G, Dreinhofer K, Bucking B, Becker C, Benzinger P . Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2018; 52(1):10-16. PMC: 6353815. DOI: 10.1007/s00391-018-1382-z. View

Jamal A, Hasan Khan M, Sadiq M . Intertrochanteric Hip Fractures And Vitamin D Deficiency; A Significant Association. J Ayub Med Coll Abbottabad. 2021; 33(2):257-261. View

Nowson C . Prevention of fractures in older people with calcium and vitamin D. Nutrients. 2012; 2(9):975-984. PMC: 3257715. DOI: 10.3390/nu2090975. View

Ingstad F, Solberg L, Nordsletten L, Thorsby P, Hestnes I, Frihagen F . Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporos Int. 2020; 32(5):873-881. DOI: 10.1007/s00198-020-05739-9. View

Larrosa M, Gomez A, Casado E, Moreno M, Vazquez I, Orellana C . Hypovitaminosis D as a risk factor of hip fracture severity. Osteoporos Int. 2011; 23(2):607-14. DOI: 10.1007/s00198-011-1588-z. View

10.

Bischoff-Ferrari H, Willett W, Wong J, Giovannucci E, Dietrich T, Dawson-Hughes B . Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005; 293(18):2257-64. DOI: 10.1001/jama.293.18.2257. View

11.

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

12.

Niikura T, Oe K, Sakai Y, Iwakura T, Fukui T, Nishimoto H . Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population. J Orthop Surg (Hong Kong). 2019; 27(3):2309499019877517. DOI: 10.1177/2309499019877517. View

13.

Khadgawat R, Brar K, Brar K, Gahlo M, Yadav C, Malhotra R . High prevalence of vitamin D deficiency in Asian-Indian patients with fragility hip fracture: a pilot study. J Assoc Physicians India. 2011; 58:539-42. View

14.

Nieves J, Bilezikian J, Lane J, Einhorn T, Wang Y, Steinbuch M . Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2009; 21(3):399-408. DOI: 10.1007/s00198-009-0962-6. View

15.

Vellingiri K, Ethiraj P, S N, Shanthappa A, S J K . Assessment of Vitamin D Levels and Its Correlation With Osteoporosis and Fracture Site Comminution in Osteoporotic Hip Fractures in Tertiary Care Hospital. Cureus. 2021; 13(1):e12982. PMC: 7916318. DOI: 10.7759/cureus.12982. View

16.

Marks R . Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010; 3:1-17. PMC: 2866546. View

17.

Boonen S, Lips P, Bouillon R, Bischoff-Ferrari H, Vanderschueren D, Haentjens P . Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007; 92(4):1415-23. DOI: 10.1210/jc.2006-1404. View

18.

Alkhenizan A, Mahmoud A, Hussain A, Gabr A, Alsoghayer S, Eldali A . The Relationship between 25 (OH) D Levels (Vitamin D) and Bone Mineral Density (BMD) in a Saudi Population in a Community-Based Setting. PLoS One. 2017; 12(1):e0169122. PMC: 5207714. DOI: 10.1371/journal.pone.0169122. View

19.

Knobe M, Gradl G, Ladenburger A, Tarkin I, Pape H . Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany?. Clin Orthop Relat Res. 2013; 471(9):2831-40. PMC: 3734428. DOI: 10.1007/s11999-013-2834-9. View

20.

Kuchuk N, Pluijm S, van Schoor N, Looman C, Smit J, Lips P . Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab. 2009; 94(4):1244-50. DOI: 10.1210/jc.2008-1832. View