Does routine blood bone biochemistry predict vitamin D insufficiency in elderly patients with low-velocity fractures?
OBJECTIVE
Vitamin D deficiency impairs bone mineralisation and can predispose individuals to fractures. This study aimed at testing whether measurement of plasma calcium, alkaline phosphatase, and phosphate levels could detect vitamin D insufficiency.


METHODS
During a 10-week winter period from December 2000 to February 2001, all elderly patients presenting to a general hospital in Brighton--British seaside town--with a fracture of the proximal femur and without known bone mineralisation problems were invited to participate in the study.


RESULTS
23 (63.9%) of the 36 eligible patients had insufficient levels of vitamin D, with a plasma concentration of less than 30 nmol/L. The mean parathyroid hormone level was 56 pg/mL (range, 12-193 pg/mL). 11 of the 36 patients had an elevated level of parathyroid hormone were insufficient in vitamin D. The mean plasma concentration of calcium was 2.30 mmol/L (range, 2.05-2.98 mmol/L). The mean phosphate level was 0.98 mmol/L (range, 0.40-1.79 mmol/L), and the mean alkaline phosphatase level was 91 IU/L (range, 46-127 IU/L). There was poor correlation between vitamin D insufficiency and plasma calcium, alkaline phosphatase, or phosphate levels.


CONCLUSIONS
Plasma calcium, alkaline phosphatase, and phosphate testing cannot detect vitamin D insufficiency. We recommend that vitamin D and calcium supplementation be considered for patients with low-energy hip fractures.
Singh
S K
SK
Royal Sussex County Hospital, Brighton, UK. samrendu@yahoo.co.uk
Manjure
S
S
Stott
P
P
Shetty
A
A
Iversen
S A
SA
Williams
C R
CR
D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis*