Is vitamin-D supplementation not useful in patients at risk of fractures and falls?

To evaluate numerous publications that question the bone and extraosseous benefits of vitamin D diet supplementation based on results, which often transcend to public opinion, but are not well interpreted. This may have negative consequences on compliance of patients under vitamin D supplementation. Critical appraisal of several articles on vitamin D supplementation and its relationship with fractures, falls, cardiovascular diseases, and cancer incidence. Such publications have certain limitations (i.e. patients excluded because of a diagnosis of osteoporosis, or at a higher risk for fractures and falls, or because they have a vitamin D deficiency, etc.), and conclusions and/or subsequent recommendations should be approached with caution. Our research shows that patients with osteoporosis, vitamin D deficiency, and at high risk of fractures and falls should not discontinue vitamin D supplementation (often associated with calcium). It is becoming increasingly evident that patients with hypovitaminosis D are those that gain a maximal benefit from vitamin D supplementation.

The pattern of recovery of ambulation after hip fracture differs with age in elderly patients.

BACKGROUND: The main objective of this study was to analyze the independent effect of increasing age on the recovery of different areas of functioning 1 year after hip fracture. METHODS: Consecutive 1-year survivors aged ≥ 65 years (n = 362) admitted to a single hospital for acute hip fracture surgery were followed prospectively for 1 year. Age was stratified as <75, 75-84, and ≥ 85 years. Basic activities of daily living and ambulation were measured by personal interview during hospitalization and phone contact at 3, 6, and 12 months. Longitudinal data of recovery in these areas were analyzed using generalized estimating equations. RESULTS: Older age was strongly associated with poor recovery in all areas of function, except eating. The pattern of recovery of ambulation differed with age, peaking at 6 months in the younger group and continuing for at least 12 months in the eldest group. The pattern of recovery of overall and individual activities of daily living was similar in the three age groups. Recovery of areas associated with upper extremity function peaked at 3 months, whereas areas associated with lower extremity function peaked at 6 months. CONCLUSIONS: The patterns of functional disability after hip fracture differ with areas of function and age with the oldest patients having a particular risk of decline and a prolonged time to recovery of ambulation.