The aims were to assess whether vitamin D deficiency influenced mortality risk for patients presenting with a hip fracture. A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels were assessed. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for confounding) was utilised to determine the independent association between serum vitamin D level and patient mortality. The cohort consisted of 2075 patients with a mean age of 80.7 years and 1471 (70.9%) were female. 1510 (72.8%) patients had a serum vitamin D level taken, of which 876 (58.0%) were deficient (<50nmol/l). The median follow up was 417 (IQR 242 to 651) days. During follow up there were 464 (30.7%) deaths. Survival at 1 year was significantly (p = 0.003) lower for patients who were vitamin D deficient (71.7%, 95% confidence intervals (CI) 68.6 to 74.9) compared to those who were not (79.0%, 95% CI 75.9 to 82.3). Vitamin D deficiency was also independently associated with an increased mortality risk at 2-years (HR 1.42, 95% CI 1.17 to 1.71, p = 0.03), but not at 1-year (p = 0.08). Hip fracture patients with vitamin D deficiency had an increased mortality risk. This risk was independent of confounders at 2 years. The role of measuring vitamin D levels in these patients is unclear. Improved public health policy about vitamin D may be required to reduce deficiency in this patient population

Introduction. The calcium-PTH-vitamin D-axis has long been highlighted for its effects on bone status and much interest has been given to how this relates to the risk of sustaining an osteoporotic fracture. Little attention has on the other hand been given to how disturbances in this axis, as for example secondary hyperparathyroidism (SHPT), relate to mortality among hip fracture patients. We therefore wanted to determine if SHPT could predict mortality in this group of patients. Methods. The study included 562 hip fracture patients (HF) (age 70 years) admitted to a Danish university hospital. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of approximately 248000 subjects. The control group (Con) (n=1124) consists of subjects who have had PTH, total calcium (Ca) and 25OH-vitamin D (VitD) measured at the General Practitioners Laboratory of Copenhagen after referral from their general practitioner. Of the HF's 462 had a Ca measurement, 440 had a PTH measurement and 439 had a VitD measurement. Basic characteristics (values for age, Ca, PTH and VitD are mean (SD)): Sex (females/males) (%): 73.8/26.2. Age (years): 82.9 (5.7). Ca (mmol/l): Con 2.34 (0.13), HF 2.27 (0.13), p<0.0001 (chi-square). PTH (pmol/l): Con 6.4 (5.8), HF 6.6 (5.4), p=0.4 (chi-square). VitD (nmol/l): Con 53.3 (30.1), HF 49.3 (29.6), p=0.02 (chi-square). Results. General 1-year mortality (dead/total): Con-female 9.2% (76/830), Con-male 17.7% (52/294), HF-female 24.6% (102/415), HF-male 33.3% (49/147), p<0.0001 (log rank). Prevalence of SHPT defined by PTH>7.1 pmol/l and VitD<50 nmol/l: Con 18%, HF 20%, p=0.2 (chi-square). SHPT and related 1-year mortality (dead/total): Con-nonSHPT 9.7% (89/922), Con-SHPT 19.3% (39/202), HF-nonSHPT 22.7% (78/343), HF-SHPT 34.9% (30/86), p<0.0001 (log rank). Discussion. Our study clearly shows that SHPT is a significant predictor of mortality in both hip fracture patients and the control group as mortality is significantly higher among subjects suffering from SHPT. The effect of SHPT on mortality appears early on among the hip fracture patients after which the mortality parallels the other groups. In accordance with the literature, we found that the general 1-year mortality among hip fracture patients is significantly increased compared to an age- and sex-matched control group. The fact that the prevalence of SHPT is not significantly higher among the hip fracture patients than in the control group in our study is a bit surprising but might be due to a higher degree of awareness of vitamin D deficiency among elderly patients at risk of hip fractures and a higher level of vitamin D supplementation in this group

Aims

To evaluate the effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D and a long bone fracture.

Aims

Hip fractures in patients < 60 years old currently account for only 3% to 4% of all hip fractures in England, but this proportion is increasing. Little is known about the longer-term patient-reported outcomes in this potentially more active population. The primary aim is to examine patient-reported outcomes following isolated hip fracture in patients aged < 60 years. The secondary aim is to determine an association between outcomes and different types of fracture pattern and/or treatment implants.

Aims

The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment.

Objectives

Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs.