Bone Joint J 2013 vol. 95-B no. SUPP 1 1
A de Jong, K Woods, M Suresh and M Porteous; Bury St. Edmunds, United Kingdom
Introduction Assessment for and treatment of osteoporosis is recommended following hip fracture. All forms of osteoporosis treatment require an adequate calcium intake and normal vitamin D levels. This study assesses vitamin D levels in patients with hip fractures and describes guidelines on how to manage low vitamin D levels with high dose oral vitamin D3 (cholecalciferol).
Materials and methods Circulating 25-hydroxyvitamin D levels were measured in consecutive patients with a hip fracture over an 18 month period. Substitution therapy with high dose oral cholecalciferol was started in 2 selected cohorts; one group received substitution therapy for 3 days, the second group for 7 days.
Results 381 patients with 387 hip fractures were included.
Only 27 patients had sufficient (>75 nmol/L) vitamin D levels (mean 91.2 nmol/L) and of these 22 were taking supplements. The remainder, 354 patients, had low vitamin D levels (mean 26.4 nmol/L).
Substitution with 50,000 IU cholecalciferol daily for 3 days in 14 patients resulted in an increase in vitamin D levels from 29.6 nmol/L to 81.4 nmol/L (p < 0.0001), at a mean of 14 days. 71% of patients achieved levels above the desired threshold of 75 nmol/L.
Substitution with 50,000 IU cholecalciferol for 7 days in 54 patients resulted in an increase in vitamin D levels from 31.4 nmol/L to 131.1 nmol/L (p < 0.0001), at a mean of 16 days.
100% of patients achieved levels above the desired threshold. No clinical or biochemical side effects were reported.
Discussion Virtually all patients who are not taking vitamin D supplements and sustain a hip fracture have abnormally low circulating vitamin D levels and all require substitution.
The routine measurement of vitamin D levels may be unnecessary.
Substitution with 50,000 IU oral cholecalciferol daily for 7 days increases vitamin D levels rapidly, safely and consistently.
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This is great,
Would have been far better if the people had enough vitamin D and cofactors so as to not have a hip fracture in the first place
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