Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture †.

The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. OBJECTIVES: (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2⁻13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6⁻39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.

[Vitamin D supply of patients with hip fracture]. / A csípotáji csonttörést szenvedett betegek D-vitamin-ellátottsága.

INTRODUCTION: Vitamin D deficiency is an important risk factor for fractures. However, there are few data available only on the relationship between serum 25-hydroxyvitamin D levels and recovery after surgery for hip fracture. AIM: The authors investigate the vitamin D supply of patients with hip fractures. METHOD: Between February and September 2013, serum 25-hydroxyvitamin D and parathyroid hormone levels were determined in 203 patients with hip fracture (74.8±11.5 ys; 67 men and 136 women) and in 74 control subjects. RESULTS: Vitamin D deficiency and secondary hyperparathyroidism occurred significantly more frequently in patients with hip fracture than in control subjects (72% vs. 45%, and 33% vs. 17%, respectively). Patients with better condition after surgery showed higher 25-hydroxyvitamin D levels (p<0.001) than those with poor condition. Serum 25-hydroxyvitamin D were lower in the 31 patients who died [median of survival time: 19 (5-52) days] compared to those who survived [22.6 (9.5-45.0) vs. 33.0 (16.5-56.6) nmol/l]. CONCLUSIONS: The association between vitamin-D deficiency and mortality as well as the positive correlation between serum 25-hydroxyvitamin D levels and better postoperative condition confirm the importance of proper vitamin D supply in the prevention and cure of hip fractures, what is more in the increase of the chance of survival.