title: Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy.
abstract: To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.
authors.affiliation: Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia. alex.fisher@act.gov.au
authors.forename: A
authors.initials: A
authors.lastname: Fisher
authors.forename: S
authors.initials: S
authors.lastname: Goh
authors.forename: W
authors.initials: W
authors.lastname: Srikusalanukul
authors.forename: M
authors.initials: M
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000175:diagnosis*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D