title: The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study.
abstract: The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture. The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic materials or casts. Thirty women (mean age = 78 years; range = 58-88) with a PHF, osteoporosis or osteopenia (based on a hip scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period, with peak levels in week 6. By week 6 BMD levels were higher in the active group (0.623 g/cm2) compared with the placebo group (0.570 g/cm2, P = 0.006). Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l, indicative of mild vitamin D insufficiency. In conclusion, we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other osteogenic bone agents such as bisphosphonates remains to be examined.
authors.affiliation: Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark. doetsch@mail.dk
authors.forename: A M
authors.initials: AM
authors.lastname: Doetsch
authors.forename: J
authors.initials: J
authors.lastname: Faber
authors.forename: N
authors.initials: N
authors.lastname: Lynnerup
authors.forename: I
authors.initials: I
authors.lastname: Wätjen
authors.forename: H
authors.initials: H
authors.lastname: Bliddal
authors.forename: B
authors.initials: B
authors.lastname: Danneskiold-Samsøe
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy; D002136:Calcium, Dietary / Q000097:blood / Q000627:therapeutic use*; D002762:Cholecalciferol / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D006801:Humans; D006810:Humeral Fractures / Q000188:drug therapy*; D006811:Humerus / Q000187:drug effects; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy; D011446:Prospective Studies
chemical_list: D002136:Calcium, Dietary; D002762:Cholecalciferol