Objectives: A recent meta-analysis (JAMA. 2005;293:2257–2264) reported that supplementation with oral vitamin D 700–800 IU/day reduces the risk of hip or any nonvertebral fracture in elderly individuals by approximately 25%. However, this metaanalysis was unable to define the role of additional calcium supplementation. The aim of the current study was to assess the need for calcium supplementation in individuals receiving vitamin D for the prevention of hip and nonvertebral fractures.

Methods: MEDLINE (search terms: ‘vitamin D’ AND ‘hip fracture’), bibliographies of articles retrieved, and the authors’ reference files were used to identify randomized controlled trials (RCTs) of oral vitamin D supplementation with or without calcium supplementation vs placebo/no treatment in postmenopausal women and/or older men (over 50 years) specifically reporting hip fracture risk. Data extraction was independent by

Results: All pooled analyses are based on random-effects models. Based on 4 RCTs (9083 subjects), the pooled relative risk (RR) of hip fracture for vitamin D supplementation alone was 1.10 (95% confidence intervals [CI], 0.89 to 1.36). No between-trial heterogeneity was observed. For the 5 RCTs (9227 subjects) of vitamin D supplementation with calcium supplementation, the pooled RR for hip fracture was 0.79 (95% CI, 0.64 to 0.97). There was no heterogeneity between trials. The RRs for all nonvertebral fracture were 0.98 (0.83 to 0.16) for vitamin D alone and 0.84 (0.73 to 0.96) for vitamin D with calcium, with moderate heterogeneity between trials. In an adjusted indirect comparison of the summary RRs from the 2 meta-analyses, the RR for hip fracture for vitamin D with calcium vs vitamin D alone was 0.72 (95% CI, 0.53 to 0.96) and the RR for all non-vertebral fractures was 0.77 (95% CI, 0.60 to 0.99).

Conclusions: Oral vitamin D supplementation appears to reduce the risk of hip and any nonvertebral fractures only when calcium supplementation is added. Our findings suggest that to optimize clinical efficacy, vitamin D supplementation should be complemented with calcium supplements.

Objectives: To determine the magnitude and duration of excess mortality after hip fracture among postmenopausal women.

Methods: We conducted a systematic review and meta-analysis of the literature to estimate the pooled relative risk of death after hip fracture by time since fracture. We selected only controlled studies that reported data on postmenaupausal women aged 50 years or older, carried out a life-table analysis, and displayed the survival curves of the hip-fracture group and an ageand sex-matched control group. Using random-effects models we calculated the pooled relative risk of death with 95% confidence intervals (95%CI) by time since fracture.

Results: Twenty-three studies contributed to this meta-analysis. The pooled relative risk of dying within three, six, twelve, and twenty-four months following hip fracture was 5.06 (95%CI: 4.31, 5.93), 3.92 (95%CI: 3.11, 4.94), 2.71 (95%CI: 2.33, 3.14), and 2.02 (95%CI: 1.83, 2.23), respectively. Thereafter, excess mortality remained relatively constant. The relative risk of mortality at five years, ten years, and fifteen years post-fracture was 1.44 (95%CI: 1.29, 1.62), 1.40 (95%CI: 1.35, 1.45), and 1.36 (95%CI, 1.31, 1.41), respectively.

Conclusions: Excess mortality among postmenopausal women having suffered a hip fracture was most apparent immediately after the event, declined steeply during the first years post-fracture, but did not return to that of age- and sex-matched controls, even at the longest duration of follow-up. The impact of a hip fracture on excess mortality among postmenopausal women continued for up to 15 years.

Purpose: We conducted a prospective study among elderly women with a first hip fracture to document survival and functional outcome, and to determine whether outcomes differ by fracture type.

Methods: The design was a one-year prospective cohort study in the context of standard day-to-day clinical practice. The main outcome measures were survival and functional outcome, both at hospital discharge and one year later. Functional outcome was assessed using the Rapid Disability Rating Scale version-2.

Results: Of the 170 women originally enrolled, 86 (51%) had an intertrochanteric and 84 (49%) a femoral neck fracture. There were no significant differences between the two groups with respect to median age (80 and 78 years, respectively), type and number of comorbidities, and prefracture residence at the time of injury. At hospital discharge, intertrochanteric hip-fracture patients had a higher mortality (relative risk [RR] 9.8; 95% confidence interval [CI]: 1.3 to 74.6; p=0.006) and were functionally more impaired (0.4 units difference in ability to walk independently; p=0.005). One year later, mortality was still significantly higher after intertrochanteric fracture (RR 2.5; 95% CI: 1.3 to 5.1; p=0.008), but functional outcome among surviving patients was similar in both groups. During the one-year period after hospital discharge, a significant functional recovery was observed regardless of fracture type (improvement by 3.9 units [p=0.003] and by 2.6 units [p=0.015] in patients with intertrochanteric and femoral neck fractures, respectively). In both groups, this recovery was reflected in a significant improvement in walking ability (p< 0.001 and p=0.006, respectively) and mobility (p=0.004 and p< 0.001, respectively).

Conclusions: We conclude that intertrochanteric fractures are associated with increased mortality compared to femoral neck fractures. Functional outcome differs according to fracture type at hospital discharge, but these differences do not persist over time. Our data provide evidence that these findings cannot be explained by differences in age or comorbidity. Differences in survival suggest that the two main types of hip fractures should be analyzed separately in clinical and epidemiological studies.