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Vitamin D loading dose after hip fracture surgery was great – RCT Aug 2016

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

VitaminDWiki Summary

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

  1. Had higher level of vitamin D years before - so as to no have hip fracture in the first place
  2. 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

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Pages listed in BOTH the categories Falls/Fracture and Meta-analysis

Falls/Fracture Intervention trials (give Vitamin D and see what happens)

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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.

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.

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.

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).

Attached files

ID Name Comment Uploaded Size Downloads
6991 Falls chart.jpg admin 21 Aug, 2016 14:57 19.24 Kb 619
6990 Falls.jpg admin 21 Aug, 2016 14:57 13.09 Kb 582
6989 Loading dose hip fracture surgery.pdf PDF 2016 admin 21 Aug, 2016 14:56 815.44 Kb 517