Submitted to: Journal of Bone and Mineral Research
Publication Type: Abstract Only
Publication Acceptance Date: 6/28/2008
Publication Date: 9/12/2008
Citation: Bischoff-Ferrari, H.A., Staehelin, H.B., Dawson-Hughes, B., Platz, A., Can, U., Looser, S., Bretschner, B., Theiler, R. 2008. Red Flags Are Missed in the Prevention of Hip Fractures: Baseline Results of the Zurich Hip Fracture Trial. Journal of Bone and Mineral Research. 23(Suppl1):SU432.
Technical Abstract: From January 2005 to December 2007, we recruited 173 patients age 65 and older with acute hip fracture and a Folstein mini mental score of at least 15 into an ongoing double-blind RCT with vitamin D. 69% of hip fracture patients were admitted from home and 31% from institutions, 79% were women. Mean age was 86 year (+/- 6.9). We present results from 3 self-reported "red flag" questions answered 3 to 7 days after the acute hip fracture that should have triggered vitamin D supplementation prior to the hip fracture event. Upon admission to acute care, only 12% of hip fracture patients enrolled had any dose of vitamin D including multivitamin formulations. Mean 25(OH)D was 31.3 nmol/l (+/- 19) in hip fracture patients admitted from home and 33.3 nmol/l (+/- 23) in those from institutionalized care. 51% of hip fracture patients admitted from home and 54% admitted from institutions had severe vitamin D deficiency (25(OH)D of less than 30 nmol/l). 48% of hip fracture patients admitted from home and 51% of those admitted from institutions reported that they had a previous fracture outside the hip prior to the acute hip fracture event. Of those admitted from home, 29% reported that they had fallen rarely and 20% that they had fallen repeatedly in the last 6 month prior to the acute hip fracture event. Similarly, of those admitted from institutions, 27% reported that they had fallen rarely and 34% that they had fallen repeatedly in the last 6 month prior to the acute hip fracture event. Furthermore, 33% of those admitted from home and 24% from institutions reported that they felt weakness in their legs 6 months prior to their acute hip fracture event. Vitamin D supplementation for the prevention of falls and fractures is recommended in several guidelines, however, according to our data collected between 2005 and 2007, guideline practice is still low. The positive report of red flags including previous fractures, previous falls, and muscle weakness is common in patients with acute hip fracture and may help increase guideline practice in older individuals.