Hip fractures and low Vitamin D - many studies

Hip fracture recovery was worst when vitamin D was below 10–12 ng - review

Vitamin D Deficiency in Hip Fracture Patients: Outcome-Specific Associations and Post-Fracture Management—A Narrative Review

Medicina (MDPI), Sept 17, 2026, https://doi.org/10.3390/medicina62091794

Hannah Lee, Jaehee Lee, Yejun Lee, Suk-Kyoon Song

Summary by Claude Opus 5.5 - September 2026

Bottom line: In older adults who break a hip, severe vitamin D deficiency (below about 10–12 ng/mL) was the level most consistently tied to poor recovery of walking. The authors recommend checking and correcting vitamin D as part of post-fracture care. However, the supplementation trials they reviewed did not show that vitamin D by itself improves recovery.

This is a narrative (non-systematic) review from Korea. It covers 14 observational studies and meta-analyses and 10 intervention or care-pathway studies.

Observational findings

  • Compared with patients below 12 ng/mL, those at any higher level had 2.6–3.7 times the odds of walking 10 feet unaided at 30 and 60 days (n = 290).
  • Below 20 ng/mL was linked to delirium (OR 1.5) and pneumonia (OR 3.8) in 1,029 patients.
  • A meta-analysis of 18 cohorts (10,237 patients) found 2.3X higher mortality below 20 ng/mL, with no significant increase at 20–30 ng/mL. A second meta-analysis found the mortality link disappeared after adjusting for other risk factors.
  • Below 20 ng/mL was linked to 2.8X the odds of a second hip fracture within a year.

Supplementation trials

  • A single 250,000 IU D3 loading dose did not improve gait speed. Both groups also got 800 IU + 500 mg calcium daily. Falls were 6.3% vs 21.1%, but the trial was not powered to test falls.
  • 2,000 IU/day was no better than 800 IU/day. What helped was 800 IU combined with home exercise.
  • Calcifediol 266 µg daily for 5 days and weekly for 5 weeks both reached about 35–38 ng/mL at 1 month.

The authors conclude the open question is "whether targeted correction of severe deficiency … can meaningfully improve functional recovery."

What this does not show / limitations

  • It is a narrative review: there was no independent screening and no risk-of-bias grading, and the authors chose which studies to cite.
  • The outcome links are observational. Low vitamin D may partly be a marker of frailty and malnutrition, and levels were measured after the fracture, when they are known to drop.
  • None of the trials enrolled only severely deficient patients, doses were modest, and the review reports achieved 25(OH)D for only one trial. These trials are weak tests of whether vitamin D helps.

PDF

The Impact of Vitamin D Deficiency on Outcomes After Hip Fracture Surgery: A Systematic Review and Meta-analysis - Aug 2026

Indian Journal of Orthopaedics https://doi.org/10.1007/s43465-026-01932-w PDF behind a paywall

Kyle P. O’Connor, Vincent M. Dieu, Steven G. Stagg & John T. Riehl

Background: Vitamin D deficiency (VDD) is a highly prevalent among hip fracture patients. Although hypovitaminosis D has negative effects on bone health, infections, and frailty, its effect on postoperative outcomes after hip fracture surgery remains incompletely and inconsistently described in the literature. This review will help demonstrate the impact of VDD on patients sustaining hip fractures.

Methods: The search was conducted using OVID Medline, Embase, SCOPUS, Cochrane, PubMed, and clinicaltrials.gov. Included studies compared postoperative outcomes between VDD (mostly < 20 ng/mL) and control (≥ 20 ng/mL) groups. Fracture morphology included femoral neck fractures as well as intertrochanteric and subtrochanteric femur fractures. The primary outcome of interest was mortality while secondary outcomes included complications and length of stay. Random-effects meta-analysis was conducted and reported as odds ratios (OR) and effect sizes (ES).

Results: Eighteen studies met the inclusion criteria.

  • A total of 10,407/20,544 (51%) patients had VDD.
  • At 30 days, mortality rates were 4.5% and 3.1% with and without VDD, respectively.
  • At 1 year, mortality rates were 22.1% and 17.1%, respectively.
  • Rates of venous thromboembolism (VTE) were 3.7% and 2.1%, respectively.
  • Length of stay was 12.0 ± 6.4 days and 10.1 ± 4.5 days, respectively.
  • For VDD, meta-analysis determined that there were increased odds of mortality
    • at 30 days (OR: 1.42, CI 1.18–1.70) and
    • at 1 year (OR: 1.34, CI 1.11–1.62) as well as
  • increased odds of VTE at 1 year (OR: 2.05, CI 1.17–3.61).
  • Length of stay was longer for VDD (ES: 0.30, CI 0.05–0.55). All p values for above outcomes were < 0.05. There was no association between VDD and pneumonia, UTI, delirium, surgical site infections, or implant failure.

Conclusion VDD is prevalent within the hip fracture population and was associated with increased mortality, VTE, and hospital length of stay in observational studies. The certainty of evidence was very low, and these associations do not establish causality or support routine screening or supplementation. Prospective trials are needed to determine whether such interventions improve outcomes.

Burden of screening and treatment of bone health markers amongst elderly patients with proximal femur fractures - Aug 2025

J Orthop Surg Res 2025 Aug 19;20(1):772. doi: 10.1186/s13018-025-06202-3

Alexander Yunke 1, Antonio Farinhas 2, Zachary Tamweber 1, Alexandra Wadhwani 1, Ellen Lutnick 3

Introduction: This study aims to quantify changes in the burden of screening for osteoporosis and vitamin D deficiency (VDD) amongst elderly patients treated with proximal femur fracture repair (PFFR).

Methods: Data collection and analysis was performed via the TriNetX HCO group network titled Research. Patients aged 65 and older who underwent PFFR were included based on CPT codes. Rates of preexisting diagnoses of VDD and/or osteoporosis, and first-time diagnoses of VDD or osteoporosis at 1 month, 6 months, and 1 year following PFFR between 2004 and 2024 were explored. Patient demographics and comorbidity data were compared across patient cohorts using chi-square tests for categorical variables, independent samples t-tests for continuous variables. Standardized differences were used to calculate the effect size.

Results: PFFRs registered in TriNetX have increased from 2004 to 2024 (Table 1). Those patients who underwent PFFR without prior history of VDD and/or osteoporosis ranged from 74.60% in 2004 to 49.83% in 2024.

Conversely, patients with a prior history of documented VDD and/or osteoporosis ranged from

  • 25.4% in 2004 to

  • 50.1% in 2024.

The percent risk of a first-time diagnosis of osteoporosis at 1 month, 6 months, and 1 year in the overall cohort were 3.7%, 8.6%, and 10.3%, respectively. The percent risk of a first-time diagnosis of VDD at 1 month, 6 months, and 1 year in the overall cohort were 2.1%, 4.4%, and 5.6%, respectively.

Conclusion: The burden of screening for markers of bone health and subsequent treatment in at risk patients has increased over time. Rates of first-time diagnoses of osteoporosis or VDD after PFFR represent a current treatment burden of approximately 10% and 5% of this population at 1 year, respectively. This number may underrepresent the true burden of disease, highlighting the necessity of screening protocols targeting this population.

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