Vitamin D status and complications, readmissions, and mortality after hip fracture
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ORIGINAL ARTICLE
Vitamin D status and complications, readmissions, and mortality after hip fracture F. Ingstad 1,2
&
L. B. Solberg 1 & L. Nordsletten 1,3 & P. M. Thorsby 4 & I. Hestnes 1 & F. Frihagen 3,5
Received: 22 September 2020 / Accepted: 10 November 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. Introduction We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. Methods Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. Results A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin Ddeficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. Conclusion Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study. Keywords Delirium . Fracture healing . Hip fracture . Post-fracture complications . Prevention . Vitamin D deficiency
Introduction The number of hip fractures is estimated to increase worldwide to 2.6 million by 2025 and 4.5 million in 2050 [1]. Hip fracture * F. Ingstad [email protected] 1
Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
2
University of Copenhagen, Copenhagen, Denmark
3
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
4
Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
5
Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
rates have declined in Norway the past years [2], but the forecasted
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