An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial
BMC Musculoskeletal Disorders DOI: 10.1186/s12891-016-1174-9
Jenson CS Mak, Rebecca S. Mason, Linda Klein and Ian D. Cameron
800 IU daily and 500 mg Calcium for everyone
Loading dose of 250,000 IU for people assigned to active replacement
Far fewer falls in those getting loading dose
Would have been better if
- Had higher level of vitamin D years before - so as to no have hip fracture in the first place
- Had used larger loading dose and larger maintenance dose, along with cofactors needed to build bones
Say 400,000 IU loading and 4,000 IU maintenance
See also VitaminDWiki
- Overview Fractures and vitamin D
- Healthy bones need: Calcium, Vitamin D, Magnesium, Silicon, Vitamin K, and Boron – 2012
- Partial (proximal) hip fracture strongly associated with low Vitamin D – Aug 2016
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Hip fracture outcome 5X more likely to be poor if low vitamin D – Jan 2015
- Delirium 2.7 X more likely after hip fracture and low vitamin D – May 2015
The TOP articles in Falls/Fractures and Vitamin D are listed here:
- Low trauma bone fractures in seniors – considering Vitamin D loading dose for all, without testing – Nov 2019
- Hard bones, soft arteries, rather than vice versa (Vitamin D and Vitamin K) – March 2016
- Vitamin D compliance 3X higher when children with fractures actually knew their low vitamin D level – March 2019
- Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
- Postmenopausal women need Vitamin D, protein and exercise to prevent loss of muscle and bone – Aug 2018
- Vitamin D receptor (TT), which restricts Vit D to cells, is associated with balance problems in seniors – June 2018
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Calcium supplements proven to NOT reduce fractures, but are proven to INCREASE heart problems – July 2015
- Bone fractures in children requiring surgery were 55X more likely with low vitamin D – June 2015
- Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014
- UK would save as least 636 million dollars annually by giving 800 IU vitamin D free to all seniors – June 2014
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Yet again, 800 IU of vitamin D was found to be barely enough to help bones – Lancet Oct 2013
- Fewer heart attacks, hip fractures and deaths if more skin cancer – Sept 2013
- Following a stroke, a hip fracture is 6X more likely if low vitamin D – July 2001
- Vertigo treated by Vitamin D - many studies
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
Pages listed in BOTH the categories Falls/Fracture and Meta-analysis
- No increase in falls, fractures or all-cause mortality when Vitamin D is given monthly or less often– meta-analysis April 2024
- 100,000 IU of Vitamin D monthly (27 ng) is not enough to reduce fractures and falls – meta-analysis April 2024
- Increased risk of fracture if high level of Vitamin D (if continue to take Calcium) – umbrella analysis of meta-analyses Nov 2020
- Hip fractures not prevented by Vitamin D (800 IU daily or large quarterly or annual doses) – meta-analysis – Dec 2019
- Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
- Vitamin D not help fractures and falls if not vitamin D deficient – meta-analysis Oct 2018
- Fractures not reduced by small amounts of vitamin D - meta-analysis Dec 2017
- 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
- Fracture risk reduced somewhat by 800 IU of vitamin D and Calcium – meta-analysis Oct 2015
- Acute fracture patients – 70 percent were vitamin D deficient – meta-analysis Sept 2015
- Falls not prevented by vitamin D given every 3 months or less often – meta-analysis Jan 2015
- Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
- Bone fractures reduced by a minimum of 800 IU vitamin D and Calcium – meta-meta-analysis March 2014
- Fractures reduced with any amount of vitamin D and some Calcium - Cochraine April 2014
- Fallers often had less than 20 ng of vitamin D – meta-analysis April 2014
- Hip fractures greatly reduced by sunshine, vitamin D, and vitamin K – meta-analysis Sept 2012
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
- Hip fractures reduced 30 percent with 800 IU of vitamin D – meta-analysis July 2012
- Vitamin D reduces falls – meta-analysis Oct 2011
- Active form of vitamin D (calcitriol) cut in half the fractures following organ transplant – meta-analysis Aug 2011
- 1000 IU minimum to decrease falls and fractures Swiss - 2009
- Meta-analysis of falls and 800+ IU of vitamin D found good results – June 2010
- 800 IU vitamin D reduces falls - Dec 2009
Falls/Fracture Intervention trials (give Vitamin D and see what happens)
- Muscles improved in women with 50,000 IU vitamin D weekly (8 weeks) plus daily Magnesium – RCT Sept 2020
- Bone fractures of children not reduced if given little vitamin D, no Calcium etc. – RCT May 2023
- Falls not decreased by 60,000 IU Vitamin D monthly (not a news item) – RCT Aug 2021
- Increasing Vitamin D in aged care facilities to more than 800 IUs did not reduce falls – Oct 2020
- Grip strength following wrist fracture increased by 50,000 IU Vitamin D monthly – May 2019
- Hip fracture recovery best with home exercise plus Vitamin D – RCT Dec 2018
- Fell more often with higher doses of vitamin D (not statistically significant) – Oct 2017
- Less bone loss if take 100,000 IU vitamin D monthly – RCT Nov 2017
- Probably Fractures of the Tibia can be healed with 100,000 IU of vitamin D weekly – RCT 2023
- Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018
- 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017
- Added 1 lb of muscle to sarcopenia adults in 13 weeks with just 800 IU vitamin D and protein – RCT Jan 2017
- Monthly 100,000 IU of vitamin D decreased respiratory infection but increased falls – Nov 2016
- Elderly falls reduced 3.6 times by 900 IU of vitamin D and simple exercise – RCT Nov 2016
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
- 2X fewer Senior falls in group getting 100,000 IU vitamin D monthly via Meals-on-Wheels – RCT Aug 2015
- Rate of injuries from falls cut in half by just 800 IU of vitamin D and exercise – RCT May 2015
- Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Hip fracture reduced 38 percent with Calcium and just 400 IU of vitamin D – RCT Feb 2013
- Hip bone loss stopped with 1000 IU of vitamin D, while 400 IU similar to placebo – RCT April 2013
- Vertigo treated by Vitamin D - many studies
- 39% fewer falls with 2000 IU than 800 IU – RCT June 2010
Download the PDF from VitaminDWiki
Background
Improving vitamin D (25-OHD) status may be an important modifiable factor that could reduce disability severity, fall-rates and mortality associated after hip fracture surgery. Providing a loading-dose post-surgery may overcome limitations in adherence to daily supplementation.
Method
In this randomized, double-blind, placebo-controlled trial, 218 adults, aged 65-years or older, requiring hip fracture surgery were assigned to receive a single loading-dose of cholecalciferol (250,000 IU vitamin-D3, the REVITAHIP - Replenishment of Vitamin D in Hip Fracture strategy) or placebo, both receiving daily vitamin-D(800 IU) and calcium (500 mg) for 26-weeks. Outcome measures were 2.4 m gait-velocity, falls, fractures, death (Week-4), 25-OHD levels, quality-of-life measure (EuroQoL) and mortality at weeks-2, 4 and 26.
Results
Mean age of 218 participants was 83.9(7.2) years and 77.1 % were women. Baseline mean 25-OHD was 52.7(23.5)nmol/L, with higher levels at Week-2 (73 vs 66 nmol/L; p = .019) and Week-4 (83 vs 75 nmol/L; p = .030) in the Active-group, but not at Week-26. At week-4, there were no differences in 2.4 m gait-velocity (0.42 m/s vs 0.39 m/s, p = .490), fractures (2.7 % vs 2.8 %, p = .964) but Active participants reported less falls (6.3 % vs 21.1 %, 2 = 4.327; p = 0.024), with no significant reduction in deaths at week-4 (1 vs 3, p = 0.295), higher percentage reporting ‘no pain or discomfort’ (96.4 % vs 88.8 %, p = 0.037), and trended for higher EuroQoL-scores (p = 0.092) at week-26. One case of hypercalcemia at week-2 normalised by week-4.
Conclusion
Among older people after hip fracture surgery, the REVITAHIP strategy is a safe and low cost method of improving vitamin-D levels, reducing falls and pain levels.
Trial registration
The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066 (Date of registration: 14/05/2010).