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Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019

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

VitaminDWiki

Falls and Fractures category contains the following

Hip fracture


Tests for Vitamin D contains the following overview/opinion


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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