Ideal vitamin D level is reported to be >30 ng/mL to allow for normal mineralization of bone, optimization of calcium absorption, and to prevent osteomalacia and secondary hyperparathyroidism. Low vitamin D is a risk factor for osteoporotic fractures that may be independent of osteoporosis by directly affecting bone mineralization, muscle strength and balance. This bone qualitative defect can only be corrected by adequate vitamin D replacement. We report the prevalence of vitamin D inadequacy in a population of adults with non-traumatic fractures.
To evaluate the impact of nurse-practitioner consultation, 82 adults (ages 52-97 with 63% age 80+) consecutively hospitalized with hip and extremity fractures between August 2001 and January 2002 were recruited from two St. Paul, MN hospitals (latitude 42 degrees). Patients came from independent living and assisted living facilities. Demographics, medical history, and vitamin D supplementation were obtained by self-report. Blood specimens were collected during hospitalization within 48 hours of admission. Serum 25-hydroxyvitamin D [25 (OH)D] levels were performed using Diasorin 25-hydroxyvitamin D radioimmunoassay kit (RIA; normal values are 8-30 ng/mL determined in wintertime in Rochester, MN) at Mayo Clinic, Rochester, MN. Results of 25(OH)D levels were available for 78 patients and are included in the current analysis.
Patients were 99% Caucasian, 63% ≥80 years and 78% female. On admission, 9% reported using at least 800 IU per day of vitamin D through supplements (including multivitamins) and 12% were on osteoporosis medication (3 estrogen, 5 alendronate, 1 etidronate, 1 raloxifene). The mean 25 (OH)D level was 14.2 (SD 6.6) with a range of 5-39 ng/mL.
The majority (82%) of the patients had 25 (OH)D levels ≤20 ng/mL, including 19.2% < 8 ng/mL and 97.4% of patients had 25 (OH)D levels < 30 ng/mL. Mean 25(OH)D levels were not substantially different by gender, age, or osteoporosis medication use. Patients who reported vitamin D supplementation ≥800 IU/day had significantly greater mean 25 (OH)D level, albeit suboptimal, compared to those did not (19.0 vs. 13.7; p = 0.04).
Vitamin D inadequacy is common in hospitalized fracture patients, even those who reported sufficient supplementation. Significant opportunity exists to ensure adequate and persistent vitamin D intake in patients at risk for fractures.
Disclosure Information:
Faculty Member's Name: Christine Simonelli, MD
Grants/Research Support: Merck & Co., Inc.
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