Hip fractures and low Vitamin D - many studies

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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