The prevalence of vitamin D deficiency in patients admitted with low trauma fractures - is pragmatic vitamin D supplementation appropriate?
Endocrine Abstracts (2019) 65 P88 | DOI: 10.1530/endoabs.65.P88
Presented at Society for Endocrinology BES 2019, Brighton, UK, 11 - 13 Nov 2019
Emma Eldridge, Sherwin Criseno, Mayla Buensalido & Neil Gittoes
Falls and Fractures category contains the following
213 items in FALLS and FRACTURES
- see also Overview Seniors and Vitamin D
- Overview Fractures and Falls and Vitamin D
- Search VitaminDWiki for "HIP FRACTURE" 1310 items as of April 2019
Tests for Vitamin D contains the following overview/opinion
- Fact: Many countries no longer pay for more than 1 (some not pay for even a single Vit D test)
They feel that Vit D testing is not needed except for a few conditions (Rickets, etc) Japan is an exception
- Fact: Vit D tests are not very accurate
The best lab tests have accuracies and repeatabilities of +-5 ng
Many lab tests have accuracies and repeatabilities of +- 10 ng - or worse
Vitamin D deficiency of a group - 15% to 48%
- Fact: Low-cost office/home Vit D tests are available around the world (not US as of 2018)
Low-cost 35 ng Y/N test by Nanospeed
Low-cost Vitamin D testers (about 13 dollars in quantity) – Feb 2018 Nanospeed
Quick, free, self test for deficiency
- Fact: 3 major Vit D gene problems are not noticed by Vit D tests
~ 20% of people have poor Vit D genes
Hint that Vit D not getting to cells: Vit D related diseases run in your family
Another hint - you have one of the 40 diseases which are 2X more likely if have poor genes
- Fact: A Vit D test will rarely (<1 in 1000) indicate that you are getting too much
- Opinion: If only getting a single test, wait till after supplementing with Vit D
3 months after starting a maintenance dose or 4 weeks after a loading dose
- Overview Loading of vitamin D
- Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013
- Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
- Hip fracture 58 percent more likely if low vitamin D – meta-analysis March 2017
- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
- many more studies since then, but gave up counting
- 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017
Items in both categories Loading and Testing are listed here:
Aim: This study evaluated the prevalence of vitamin D deficiency in patients admitted with low trauma fracture (LTF). We also explored whether there was a rationale to offer appropriate and safe high dose vitamin D supplementation on admission for patients who are not already on vitamin D supplementation to avoid delay in commencing active bone protection treatment if required.
Patients and methods: Using the FLS database, 1460 patients over the age of 50 years seen and assessed during their in-patient admission between January 2015 and December 2017 were identified. Data on serum vitamin D level were collected and analysed.
Results: Of the 1460 inpatients seen by the FLS team, data on vitamin D results from 831 patients were included in the analysis. 629 patients were excluded as 331 did not have their vitamin D levels checked and 298 patients were already on vitamin D supplementation on admission. From the 831 patients, 68% (n=558) were female and 32% (n=273) were males.
Using the National Osteoporosis Society classification,
- 19% of patients were vitamin D replete (serum vitamin D level of >50 nmol/l),
- 24% were vitamin D insufficient (serum vitamin D level of 31–50 nmol/l) and
- 57% were vitamin D deficient (serum vitamin D level of < 30 nmol/l).
Subgroup analysis showed that vitamin D deficiency is highly prevalent amongst patients of 60 years and over and those admitted with fractured neck of femur.
Conclusion: This study highlights the high prevalence of vitamin D deficiency in patients admitted with LTF. This finding raises the potential benefit of a pragmatic approach of offering this group of patients with reasonable and adequate loading dose of vitamin D without the need for testing. A follow up study to determine whether this regimen actually renders patients replete with vitamin D is now needed.
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