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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #218975
Title: Severe Vitamin D Deficiency in Swiss Hip Fracture Patients

Author
item BISCHOFF-FERRARI, HEIKE - UNIV HOSPITAL, ZURICH
item CAN, UENAL - TRIEMLISPITAL, ZURICH
item STAEHELIN, HANNES - UNIV HOSPITAL, BASEL
item PLATZ, ANDREAS - TRIEMLISPITAL, ZURICH
item Dawson-Hughes, Bess
item HENSCHKOWSKI, J - UNIV HOSPITAL, ZURICH
item MICHAEL, BEAT - UNIV HOSPITAL, ZURICH
item THEILER, ROBERT - TRIEMLI HOSP, ZURICH

Submitted to: Bone
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/21/2007
Publication Date: 3/8/2008
Citation: Bischoff-Ferrari, H.A., Can, U., Staehelin, H., Platz, A., Dawson-Hughes, B., Henschkowski, J., Michael, B., Theiler, R. 2008. Severe Vitamin D Deficiency in Swiss Hip Fracture Patients. Bone. 42(3):597-602.

Interpretive Summary: Based on evidence for fall and fracture prevention, most clinical guidelines recommend 800 IU of vitamin D per day for the prevention of hip fractures. This level of supplementation brings the blood level of 25-hydroxyvitamin D to between 60 and 100 nmol/L. As a direct test of clinical guideline practice in Switzerland, we measured 25-hydroxyvitamin D levels in 222 consecutive patients admitted to the hospital with acute hip fractures. The average 25-hydroxyvitamn D level among these patients was less than 35 nmol/L. This indicates that these patients were not taking 800 IU of vitamin D per day. This study provides direct evidence that further effort is needed to promote adherence to current guidelines for the prevention of hip fractures.

Technical Abstract: Background: Based on evidence for fall and fracture prevention, most clinical guidelines for the prevention of hip fractures recommend 800 IU vitamin D per day. This dose shifted 25(OH)D levels in previous studies to between 60-100 nmol/l. Aim: As a direct test of clinical guideline practice in Switzerland, we measured 25(OH)D levels in individuals age 65 and older admitted with acute hip fracture. Methods: 222 consecutive patients were investigated over a 12 month period. Mean age of patients was 86 years (range: 65 to 101) and 77% were women. Prior to admission, 63% of individuals lived at home, 22% were in assisted living situations (AL), and 15% were in nursing homes (NHs). Results: Absolute mean 25(OH) D levels were low among hip fracture patients admitted from home (34.6 nmol/l), from AL (27.7 nmol/l), and from NHs (24 nmol/l; ANOVA: p = 0.02). Severe vitamin D deficiency below 30 nmol/l was present in 60% of individuals, 80% were below 50 nmol/l, and less than 4% reached desirable levels of at least 75 nmol/l. Consistently, only 10% of hip fracture patients had any vitamin D supplementation on admission to acute care: 25(OH)D levels differed significantly between those not supplemented with vitamin D (mean = 28.2 nmol/l), those supplemented with 200-440 IU/day (mean = 53 nmol/l), and those supplemented with 800-880 IU per day (mean = 63.5 nmol/l; ANOVA: p < 0.0001). Despite low 25(OH) D levels, a clear seasonal pattern was present in all subgroups with lowest levels in the spring and highest levels in the summer and fall season (ANOVA: p = 0.03). In a multivariate analysis controlling for age and gender, vitamin D supplementation, type of dwelling, and season were independently and significantly associated with 25(OH) D levels.Conclusion: These data provide evidence that current guidelines for the prevention of hip fractures need further effort to be translated into clinical practice.