Osteoporosis International, pp 1–8, First Online: 08 November 2016, DOI: 10.1007/s00198-016-3819-9
N. Binkley D nbinkley at wisc.edu. Coursin D. Krueger P. Iglar J. Heiner R. Illgen M. SquireJ. Lappe P. Watson K. Hogan
- 24 years ago hip fractures were reduced 24 percent in a large trial using Vitamin D and Ca – Oct 2016
- Hospital found that Vitamin D saves money by improving bone fracture healing– March 2016
- 4 fewer days in hospital after hip or knee replacement if good level of vitamin D – June 2016
- 20 percent change in vitamin D levels of critically ill during a 24 hour period – Oct 2011
- Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013
- Hip fractures greatly reduced by sunshine, vitamin D, and vitamin K – meta-analysis Sept 2012
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
Reduce the need for hip replacement
- Total hip replacement: 14 times more likely to redo if low vitamin D – March 2017
Fracture liaison services often perform laboratory testing, but these results may be altered by surgery. In 40 hip arthroplasty patients, many laboratory parameters of bone health relevance were reduced by 8–22% on the first post-operative day. Laboratory results obtained in the immediate post-surgery interval do not reliably ascertain baseline status.
As secondary causes of osteoporosis are common, fracture liaison services often perform laboratory testing in the immediate post-fracture interval. We hypothesized that laboratory results obtained shortly after surgery may not accurately ascertain baseline status. If true, such alterations might confound subsequent fracture prevention efforts.
Patients undergoing elective total hip arthroplasty were studied as a surrogate for hip fracture patients. Blood and urine were obtained 2 weeks before surgery, before anesthetic induction, on post-operative day one, and 6 weeks after surgery. Serum total and free 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), calcium, creatinine, albumin (Alb), alkaline phosphatase (ALP), plasma hemoglobin (Hgb) and urinary DBP/creatinine ratio (UDBP/Cr) were measured.
Forty volunteers (28 women; 12 men) with mean age of 65.7 8.7 years were studied. Laboratory results were stable from 2 weeks before to the day of surgery. On the first day after surgery, total 25(OH)D, DBP, calcium, creatinine, ALP, and Alb declined 8–22% (p < 0.0001); free 25(OH)D and Hgb declined by 8 and 15% (p < 0.01), respectively; and UDBP/Cr increased 32% (p < 0.01). Using a 25(OH)D <30 ng/mL threshold, vitamin D inadequacy prevalence increased from 38% before surgery to 68% the day after (p < 0.001). All laboratory values returned to baseline at 6 weeks after surgery.
Laboratory values are reduced immediately following elective total hip arthroplasty. Testing at that time does not accurately ascertain baseline status and may lead to elevated estimates of vitamin D inadequacy, incorrect interventions, and misallocation of healthcare resources.