Time trend 2000-2013 of vitamin D status in older people who sustain hip fractures: steps forward or steps back? A retrospective study of 1599 patients.

BACKGROUND: Substantial proportions of hip-fracture patients have very low serum levels of 25-hydroxyvitamin D, which can negatively affect rehabilitation. However, it is not known whether changes in vitamin D deficiency have occurred over the last years in the patients who sustain hip fractures. AIM: To assess time trend 2000-2013 of calcifediol serum levels in the hip-fracture patients admitted to our rehabilitation division. DESIGN: Retrospective observational study. SETTING: A rehabilitation hospital division. POPULATION: A number of 1599 inpatients with a hip fracture admitted between January 1, 2000 and December 31, 2013 to our rehabilitation division. METHODS: A blood sample was collected in the morning following an overnight fasting 14.4±4.4 (mean±SD) days after surgery. We assessed 25-hydroxyvitamin D levels by an immunoenzymatic assay. RESULTS: Calcifediol levels increased till 2006-2007 and decreased afterward. In 2006-2007, the median 25-hydroxyvitamin D level (13.1 ng/mL, interquartile range 7.9-25ng/mL) was significantly higher (P<0.001) than the one found in both the periods 2000-2001 (5.4 ng/mL, interquartile range 3.5-9 ng/mL), and 2012-2013 (7ng/mL, interquartile range 5-14 ng/mL). In the last two-year period of observation (2012-2013), 25-hydroxyvitamin D levels were slightly higher (P<0.001) than in the first one (2000-2001). The association between periods of observation and 25-hydroxyvitamin D levels persisted after adjustment for age, BMI, and sex (P<0.001). CONCLUSIONS: A significant increase in calcifediol concentrations was seen till 2006-2007, but a significant decrease was observed afterward. Finally, calcifediol levels were only slightly higher in the last two years of observation than in the first two years and severe vitamin D deficiency was common during the whole 14-year study period. CLINICAL REHABILITATION IMPACT: Heightened awareness is needed to prevent and treat vitamin D deficiency in hip-fracture patients.

Serum levels of 25-hydroxyvitamin D and functional recovery after hip fracture.

OBJECTIVE: To evaluate the association between serum levels of 25-hydroxyvitamin D (25[OH]D(3)) and functional recovery after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: A total of 350 white hip-fracture patients consecutively admitted to a rehabilitation hospital. Thirty-five patients were excluded because their hip fracture was caused by major trauma or cancer affecting the bone or they could not complete rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent 25(OH)D(3) assessment at a mean +/- standard deviation of 21.3+/-8.1 days after the hip fracture. Functional recovery was evaluated by using Barthel Index scores. RESULTS: Low levels of 25(OH)D(3) were found (median, 6.9 ng/mL). By using the Spearman rank correlation test, a significant positive correlation was observed between serum 25(OH)D(3) and Barthel Index score assessed on admission (rho=.218, P <.001) and discharge (rho=.198, P <.001), but not with the change in Barthel Index score attributable to rehabilitation. Linear multiple regression showed that the association between 25(OH)D(3) and Barthel Index score was independent of 11 confounding variables: age, sex, hip-fracture type, pressure ulcers, cognitive impairment, neurologic impairment, infections, time between fracture occurrence and 25(OH)D(3) evaluation, comorbidity, surgical procedure type, and previous hip fractures. CONCLUSIONS: In the study population, serum 25(OH)D(3) was an independent predictor of functional recovery assessed by Barthel Index score after hip fracture but not of the change in the functional score resulting from rehabilitation.

Biochemical markers of nutrition and bone mineral density in the elderly.

BACKGROUND: Protein depletion is detrimental in bone health, but the association between bone mineral density (BMD) and serum albumin is controversial. We recently showed a positive association between femur BMD and total lymphocyte count (TLC), a validated marker of protein nutrition status, in hip-fractured women. OBJECTIVE: To investigate the association between femur BMD and both serum albumin and TLC in hip-fractured men and women. METHODS: 286 of 315 hip-fractured patients (243 women and 43 men) consecutively admitted to a rehabilitation hospital were studied. BMD was measured by DXA in the unfractured femur. The correlation between BMD and both TLC and serum albumin was studied by Pearson's coefficient and Bonferroni adjustment. RESULTS: In women a positive correlation was observed between, TLC but not albumin, and BMD measured in the total femur (r = 0.26; p < 0.01), femur neck (r = 0.21, p < 0.01), trochanter (r = 0.22, p < 0.01), intertrochanteric area (r = 0.25, p < 0.01) and Ward's triangle (r = 0.17, p < 0.05). Conversely in men a positive correlation was found between albumin, but not TLC, and BMD measured in the total femur (r = 0.50, p < 0.01), femur neck (r = 0.52, p < 0.01), intertrochanteric area (r = 0.52, p < 0.01) and Ward's triangle (r = 0.49, p < 0.01). Linear multiple regression showed that the associations were independent of age, weight, height, body mass index, erythrocyte sedimentation rate, time between surgery and blood sample collection and type of hip fracture. CONCLUSION: Our results support the role of protein nutrition in bone health, at least in elderly frail patients. TLC and serum albumin were suitable markers, however sex-related differences in their usefulness were observed.

Positive association between total lymphocyte count and femur bone mineral density in hip-fractured women.

BACKGROUND: Protein depletion appears to play a detrimental role in the causes of hip fracture and low bone mineral density has been observed in protein-depleted subjects. OBJECTIVE: To investigate the association between femur bone mineral density and total lymphocyte count, a marker of the protein nutrition status, in elderly hip-fractured women. METHODS: 210 white women affected by their first hip fracture either spontaneous or due to minimal trauma consecutively admitted to a rehabilitation hospital were studied. 34 women were ruled out because of confounding factors altering their lymphocyte count. Both total lymphocyte count and bone mineral density at the unfractured femur were evaluated. The correlation between these two variables was studied by Pearson's coefficient. Bonferroni adjustment was used for multiple comparisons. Bone density was measured by DXA (Hologic QDR 4500W). RESULTS: A positive correlation was observed between lymphocyte count and bone mineral density measured at both total proximal femur (r = 0.21; p < 0.05) and intertrochanteric area (r = 0.21; p < 0.05). Stepwise linear multiple regression analysis showed that the association with total lymphocyte count was independent of age, weight, height, body mass index, time between surgery and blood sample collection for lymphocyte count and type of hip fracture (cervical or trochanteric) when bone mineral density was evaluated both at total proximal femur (p < 0.05) and intertrochanteric area (p < 0.05). CONCLUSION: Our results support the role exerted by protein nutrition in bone health, at least in elderly frail women. From this point of view, a total lymphocyte count is a suitable, inexpensive marker.