J Bone Metab.  2015 Nov;22(4):205-209. 10.11005/jbm.2015.22.4.205.

Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture

• Lee GH
• Lim JW
• Park YG
• Ha YC

• KMID: 2170129
• DOI: http://doi.org/10.11005/jbm.2015.22.4.205

Abstract

BACKGROUND
The purpose of this study was to ascertain the prevalence of vitamin D deficiency and risk factors associated with mortality in patients > or =50-year-of-age with hip fractures.
METHODS
A total of 489 patients > or =50-year-of-age who sustained a hip fracture from January 2010 to October 2014 were followed-up for a minimum of 1 year. Clinical and radiological outcomes were evaluated including prevalence of vitamin D deficiency. Crude mortality rates were calculated, and the effects of different risk factors on mortality were assessed.
RESULTS
Vitamin D deficiency was present in 76.5% of cases (n=237). The prevalence of vitamin D insufficiency was 12.3%, and only 11.2% of patients had normal vitamin D levels. Accumulated mortality was 11% (54 patients) at 1 year. A univariate analysis showed that vitamin D deficiency (P=0.012), age (P<0.001), BMI (P<0.001), type of management (P<0.001), American Society of Anesthesiologists (ASA) score (P=0.009), pre-fracture ambulatory status (P<0.001), and osteoporosis (P<0.001) were associated with mortality. A multivariate analysis performed using a Cox proportional hazards model demonstrated that ASA score (P=0.001) and pre-fracture ambulatory status (P=0.011) were independently associated with mortality after hip fracture.
CONCLUSIONS
We did not find a relationship between serum 25-hydroxy-vitamin D levels and mortality after hip fracture, although we observed a high prevalence of vitamin D deficiency and a significant association with mortality in the univariate analysis.

Keyword

Hip fractures; Mortality; Risk factors; Vitamin D

MeSH Terms

Hip Fractures
Hip*
Humans
Mortality*
Multivariate Analysis
Osteoporosis
Prevalence
Proportional Hazards Models
Risk Factors*
Vitamin D Deficiency*
Vitamin D*
Vitamins*
Vitamin D
Vitamins

Figure

• 

  Fig. 1 High prevalence of vitamin D deficiency in patients ≥50-year-of-age with hip fracture.

Reference

1. Cassell E, Clapperton A. A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporos Int. 2013; 24:99–109.

2. Leslie WD, O'Donnell S, Jean S, et al. Trends in hip fracture rates in Canada. JAMA. 2009; 302:883–889.

3. Adams AL, Shi J, Takayanagi M, et al. Ten-year hip fracture incidence rate trends in a large California population, 1997-2006. Osteoporos Int. 2013; 24:373–376.

4. Icks A, Haastert B, Wildner M, et al. Trend of hip fracture incidence in Germany 1995-2004: a population-based study. Osteoporos Int. 2008; 19:1139–1145.

5. Ha YC, Park YG, Nam KW, et al. Trend in hip fracture incidence and mortality in Korea: a prospective cohort study from 2002 to 2011. J Korean Med Sci. 2015; 30:483–488.

6. Lee SR, Ha YC, Kang H, et al. Morbidity and mortality in Jeju residents over 50-years of age with hip fracture with mean 6-year follow-up: a prospective cohort study. J Korean Med Sci. 2013; 28:1089–1094.

7. Yi H, Ha YC, Lee YK, et al. National healthcare budget impact analysis of the treatment for osteoporosis and fractures in Korea. J Bone Metab. 2013; 20:17–23.

8. Autier P, Boniol M, Pizot C, et al. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol. 2014; 2:76–89.

9. Holvik K, Ahmed LA, Forsmo S, et al. Low serum levels of 25-hydroxyvitamin D predict hip fracture in the elderly: a NOREPOS study. J Clin Endocrinol Metab. 2013; 98:3341–3350.

10. Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006; 260:245–254.

11. Song HR, Kweon SS, Choi JS, et al. High prevalence of vitamin D deficiency in adults aged 50 years and older in Gwangju, Korea: the Dong-gu Study. J Korean Med Sci. 2014; 29:149–152.

12. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987; 69:1335–1340.

13. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1–129.

14. Koval KJ, Aharonoff GB, Rosenberg AD, et al. Functional outcome after hip fracture. Effect of general versus regional anesthesia. Clin Orthop Relat Res. 1998; 37–41.

15. Looker AC, Dawson-Hughes B, Calvo MS, et al. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone. 2002; 30:771–777.

16. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266–281.

17. Bischoff-Ferrari HA, Can U, Staehelin HB, et al. Severe vitamin D deficiency in Swiss hip fracture patients. Bone. 2008; 42:597–602.

18. Choi HS. Vitamin d status in Korea. Endocrinol Metab (Seoul). 2013; 28:12–16.

19. Ginde AA, Scragg R, Schwartz RS, et al. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc. 2009; 57:1595–1603.

20. Fiscella K, Franks P. Vitamin D, race, and cardiovascular mortality: findings from a national US sample. Ann Fam Med. 2010; 8:11–18.

21. Wang JB, Abnet CC, Chen W, et al. Association between serum 25(OH) vitamin D, incident liver cancer and chronic liver disease mortality in the Linxian Nutrition Intervention Trials: a nested case-control study. Br J Cancer. 2013; 109:1997–2004.

22. Gumieiro DN, Pereira GJ, Minicucci MF, et al. Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur. Rev Bras Ortop. 2015; 50:153–158.

23. Madsen CM, Jørgensen HL, Lind B, et al. Secondary hyperparathyroidism and mortality in hip fracture patients compared to a control group from general practice. Injury. 2012; 43:1052–1057.

24. Colais P, Di Martino M, Fusco D, et al. The effect of early surgery after hip fracture on 1-year mortality. BMC Geriatr. 2015; 15:141.

25. Paksima N, Koval KJ, Aharanoff G, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis. 2008; 66:111–117.

26. Chatterton BD, Moores TS, Ahmad S, et al. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J. 2015; 97B:246–251.

27. Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, et al. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int. 2005; 16:729–736.

28. Meyer HE, Tverdal A, Falch JA, et al. Factors associated with mortality after hip fracture. Osteoporos Int. 2000; 11:228–232.

29. Karademir G, Bilgin Y, Erşen A, et al. Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors. Int J Surg. 2015; DOI: 10.1016/j.ijsu.2015.11.009.