The Prescription of Vitamin D to Fracture Patients: A Lack of Consensus and Evidence.
Journal of Orthopaedic Trauma:. Post Acceptance: September 12, 2015, doi: 10.1097/BOT.0000000000000451
Sprague, Sheila PhD; Bhandari, Mohit MD, PhD, FRCSC; Scott, Taryn MSW; Petrisor, Brad MD, MSc, FRCSC; McKay, Paula BSc; Slobogean, Gerard MD, MPH, FRCSC
Objectives: We conducted a survey to explore practice patterns regarding the assessment of hypovitaminosis D and the prescription of vitamin D in acute fracture patients. Our secondary objective was to determine if practice patterns differed between fragility and non-fragility fracture patients.
Design: Cross-sectional survey.
Setting: All surveys were completed using SurveyMonkey(R).
Patients/Participants: We surveyed surgeon members of the Canadian Orthopaedic Association and the Orthopaedic Trauma Association.
Intervention: Survey.
Main Outcome Measurements: The proportion of surgeons who routinely prescribe vitamin D to fracture patients.
Results: 397 surveys were completed. 65.8% of surgeons indicated that they routinely prescribe vitamin D to fragility fracture patients and 25.7% routinely prescribe vitamin D non-fragility fracture patients. We identified considerable variability in dosing regimens as 45 different dosing regimens were prescribed in fragility fracture patients and 29 in non-fragility fracture patients. They ranged from daily doses of 400 IU to loading doses of 600,000 IU.
The most frequently prescribed doses were
- 1,000 IU daily (14.6%),
- 2,000 IU daily (13.4%), and
- 50,000 IU weekly (8.7%).
Respondents indicated that they heavily relied upon clinical experience to guide their decisions to prescribe vitamin D to fracture patients.
Conclusions: The results of this survey demonstrate multiple areas of uncertainty and a lack of consensus in the prescription of vitamin D to fracture patients. Fragility patients frequently receive vitamin D supplementation, whereas, the majority of surgeons do not prescribe vitamin D to young fracture patients. High-quality clinical research is needed to determine if vitamin D supplementation is beneficial to fracture patients.
See also VitaminDWiki
- Overview Fractures and Falls and Vitamin D vitamin D both PREVENTS and TREATS fractures
- Bone fractures in children requiring surgery were 55X more likely with low vitamin D – June 2015
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
Pages listed in BOTH the categories Falls/Fracture and Meta-analysis
- 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)
- 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