Abstract
Introduction
Assessment for and treatment of osteoporosis is recommended following hip fracture. All forms of osteoporosis treatment require an adequate calcium intake and normal vitamin D levels. This study assesses vitamin D levels in patients with hip fractures and describes guidelines on how to manage low vitamin D levels with high dose oral vitamin D3 (cholecalciferol).
Materials and methods
Circulating 25-hydroxyvitamin D levels were measured in consecutive patients with a hip fracture over an 18 month period. Substitution therapy with high dose oral cholecalciferol was started in 2 selected cohorts; one group received substitution therapy for 3 days, the second group for 7 days.
Results
381 patients with 387 hip fractures were included. Only 27 patients had sufficient (>75 nmol/L) vitamin D levels (mean 91.2 nmol/L) and of these 22 were taking supplements. The remainder, 354 patients, had low vitamin D levels (mean 26.4 nmol/L). Substitution with 50,000 IU cholecalciferol daily for 3 days in 14 patients resulted in an increase in vitamin D levels from 29.6 nmol/L to 81.4 nmol/L (p < 0.0001), at a mean of 14 days. 71% of patients achieved levels above the desired threshold of 75 nmol/L. Substitution with 50,000 IU cholecalciferol for 7 days in 54 patients resulted in an increase in vitamin D levels from 31.4 nmol/L to 131.1 nmol/L (p < 0.0001), at a mean of 16 days. 100% of patients achieved levels above the desired threshold. No clinical or biochemical side effects were reported.
Discussion
Virtually all patients who are not taking vitamin D supplements and sustain a hip fracture have abnormally low circulating vitamin D levels and all require substitution. The routine measurement of vitamin D levelsmay be unnecessary. Substitution with 50,000 IU oral cholecalciferol daily for 7 days increases vitamin D levels rapidly, safely and consistently.
