Importance of vitamin D in hospital-based fracture care pathways.
OBJECTIVE
This project was developed to identify ways to support hospital-based improvements for the identification and management of osteoporosis following treatment of a fragility fracture.


METHODS
This is a retrospective review of medical records of sets of consecutive patients who were admitted for surgical treatment of fragility fracture following introduction of several versions of admission and discharge care pathways. Effectiveness of the admission pathway was defined as % subjects with measurement of serum 25- hydroxyvitamin D (25(OH)D) during hospitalization; effectiveness of the discharge pathway was defined as % subjects with documentation of instructions for calcium and/or vitamin D supplementation.


METHODS
This study reviewed medical records of patients admitted to hospital for surgical treatment of a fragility fracture.


METHODS
Medical records were evaluated for 98 patients older than 50-years who were admitted with a fragility fracture of the hip or femur.


METHODS
Medical records were reviewed for the % subjects with documentation of an in-hospital order for serum 25(OH)D and with documentation of instructions to patients upon discharge concerning calcium and vitamin D intake. Median value of serum 25(OH)D was calculated.


RESULTS
In accordance with the admission pathway, serum 25(OH)D was measured in 37% (36/98). The median 25(OH)D level was 19.5 ng/mL; 78% were vitamin D insufficient [serum 25(OH)D < or = 32 ng/mL] and 58% were vitamin D deficient [serum 25(OH)D < or = 20 ng/mL]. In accordance with the discharge pathway, 74% (71/96) were discharged on calcium and/or vitamin D.


CONCLUSIONS
The high prevalence of vitamin D insufficiency (78%) observed in this study affirms the importance of incorporating vitamin D supplementation in hospital-based fracture care pathways. The discharge pathway was more effective than the newer admission pathway, a finding attributable to effects of familiarity, retraining, and introduction of computer-prompts. These evolving pathways represent a much-needed paradigm shift in the care of fragility fracture patients.
Glowacki
J
J
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. jglowacki@rics.bwh.harvard.edu
LeBoff
M S
MS
Kolatkar
N S
NS
Thornhill
T S
TS
Harris
M B
MB
D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D005264:Femoral Fractures / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D009752:Nutritional Status; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D014807:Vitamin D; C104450:25-hydroxyvitamin D