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Give Vitamin D to all fracture patients – cost effective to prevent nonunions – Aug 2016

Economic Benefit of Calcium and Vitamin D Supplementation: Does It Outweigh the Cost of Nonunions?

Journal of Orthopaedic Trauma:, Aug 2016 - Vol 30 - Issue 8 - p e285–e288, doi: 10.1097/BOT.0000000000000592
Childs, Benjamin R. BS; Andres, Brendan A.; Vallier, Heather A. MD

VitaminDWiki Summary

Propose 1,600 IU of vitamin D and 1,200 mg of Calcium for only 8 weeks
   other studies have found that more is needed along with a loading dose
Propose to give the $8 worth of supplements to ALL fracture patients
   $8 cost does not include education, distribution
They anticipate it would reduce nounions by 5%
Nonunions rate is ~4%, Cost of nonunion ~$17,000
   $17,000 does not include loss of job income, suffering, or malpractice
Number needed to treat = 1000
   (1 in 25 fractures are nonion, expect 1 in 20 nonunions will be prevented)
VitaminDWiki speculates number needed to treat = 100 if use high dose and loading dose
See also VitaminDWiki

Objectives: The purpose was to evaluate economic benefit of calcium and vitamin D supplementation in orthopaedic trauma patients. We hypothesized that reduced nonunion rates could justify the cost of supplementing every orthopaedic trauma patient.

Design: Retrospective, economic model.

Setting: Level 1 trauma center.

Patients/Participants: Adult patients over 3 consecutive years presenting with acute fracture.

Intervention: Operative or nonoperative fracture management.

Main Outcome Measurements: Electronic medical records were queried for ICD-9 code for diagnosis of nonunion and for treatment records of nonunion for fractures initially treated within our institution.

Results: In our hospital, a mean of 92 (3.9%) fractures develop nonunion annually. A 5% reduction in nonunion risk from 8 weeks of vitamin D supplementation would result in 4.6 fewer nonunions per year. The mean estimate of cost for nonunion care is $16,941. Thus, the projected reduction in nonunions after supplementation with vitamin D and calcium would save $78,030 in treatment costs per year. The resulting savings outweigh the $12,164 cost of supplementing all fracture patients during the first 8 weeks of fracture healing resulting in a net savings of $65,866 per year.

Conclusions: Vitamin D and calcium supplementation of orthopaedic trauma patients for 8 weeks after fracture seems to be cost effective. Supplementation may also reduce the number of subsequent fractures, enhance muscular strength, improve balance in the elderly, elevate mood leading to higher functional outcome scores, and diminish hospital tort liability by reducing the number of nonunions.

Level of Evidence: Economic Level V. See Instructions for Authors for a complete description of levels of evidence.