Effect of 800 IU versus 2000 IU vitamin D3 with or without a simple home exercise program on functional recovery after hip fracture: a randomized controlled trial

Authors: STEMMLE, JERRA - University Of Zurich; MARZEL, ALEX - University Of Zurich; CHOCANO, PATRICIA - University Of Zurich; ORAV, ENDEL - Harvard University; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; FREYSTAETTER, GREGORY - University Of Zurich; EGLI, ANDREAS - University Of Zurich; THEILER, ROBERT - University Of Zurich; STAEHELIN, HANNES - University Of Basel; BISCHOFF-FERRARI, HEIKE - University Of Zurich

Submitted to: Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/1/2018
Publication Date: 12/11/2018
Citation: Stemmle, J., Marzel, A., Chocano, P.O., Orav, E.J., Dawson-Hughes, B., Freystaetter, G., Egli, A., Theiler, R., Staehelin, H.B., Bischoff-Ferrari, H.A. 2018. Effect of 800 IU versus 2000 IU vitamin D3 with or without a simple home exercise program on functional recovery after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine. https://doi.org/10.1016/j.jamda.2018.10.013.
DOI: https://doi.org/10.1016/j.jamda.2018.10.013

Interpretive Summary: Hip fractures in older adults result in disability, loss of independence and mortality within the first year. In this study, we tested two simple strategies, vitamin D and a home exercise program, in functional recovery after hip fracture. We enrolled 173 older adults with acute hip fractures into a 1 year trial to test the effect of 2000 IU versus 800 IU vitamin D3 per day and also to test the effect of a simple home exercise program versus standard hospital-based physiotherapy alone. The primary outcome of the trial was performance was lower extremity function, as measured in the timed up and go (TUG) test. The TUG test was performed at baseline, and after 6 and 12 months. The participants in the 800 IU vitamin D plus simple home exercise group had significantly better (faster) performance on the TUG test than those taking 800 IU of vitamin D alone. The higher dose vitamin D group, with and without exercise, did not outperform the 800 IU vitamin D alone group. In summary, our findings support the effectiveness of 800 IU vitamin D in combination with simple home exercise program when compared with 800 IU vitamin D alone, for functional recovery after hip fracture. This study supports the concept that a simple home based exercise program in combination with 800 IU per day of vitamin D may be an effective strategy to limit disability in elders after a hip fracture.

Technical Abstract: Hip fractures can lead to severe disability, loss of independence and mortality within the first year. We tested two simple strategies, vitamin D and a home exercise program, in functional recovery after hip fracture. We enrolled 173 acute hip fracture patients >/= 65 years (79.2% women; mean age 84 years; 77.4% living at home). Using a factorial design, patients were randomly allocated to 2000 IU versus 800 IU vitamin D3 and daily instruction of a simple home exercise program (SHEP) versus standard physiotherapy alone during acute care. Three objective measures of lower extremity function were assessed at baseline, 6 and 12 months, with the timed up and go test (TUG) as the primary endpoint and global test for lower extremity function, and knee flexor and extensor strength, and a self-reported physical function score (PF-10) as secondary endpoints. Linear Mixed Models regressions analyses were based on intent-to-treat, adjusting for baseline function. A significant interaction was found between vitamin D dose and SHEP for TUG (p-value 0.045). Thus, findings compared the standard of care reference 800 IU vitamin D without SHEP to three interventions arms (800 IU vitamin D3 plus SHEP; 2000 IU vitamin D3 without SHEP; 2000 IU vitamin D3 plus SHEP). For TUG, over 12 months the 800 IU D3+SHEP group performed significantly better than the standard of care group (13.8 versus 19.5 seconds; p-value 0.01). Findings for knee flexor strength were in line with TUG results suggesting 800 IU vitamin D3+SHEP as potentially more favorable intervention (p-value 0.07), while knee extensor strength and PF-10 did not differ by treatments. In summary, our findings support the efficacy of 800 IU vitamin D in combination with SHEP when compared with 800 IU vitamin D alone, for functional recovery after hip fracture.