title: Vitamin D insufficiency in osteoporotic hip fracture patients: rapid substitution therapy with high dose oral cholecalciferol (vitamin D3).
abstract: Assessment and treatment of osteoporosis are recommended following hip fracture. Osteoporosis treatment assumes an adequate calcium intake and a normal vitamin D plasma level. The authors conducted a study in three phases. Phase I: circulating 25-hydroxyvitamin D levels were retrospectively recorded from in the case records of 381 consecutive patients with 387 hip fractures, between March 2010 and September 2011. Only 27 patients had sufficient (> 75 nmol/L) circulating vitamin D, and of these 22 were taking vitamin D supplements. The remainder, 354 patients, had abnormally low vitamin D levels, with a mean value of 26.4 nmol/L. These findings confirmed literature data, and gave rise to the prospective Phase II (October 2011): 14 consecutive patients with a hip fracture received rapid substitution therapy with 50,000 IU cholecalciferol (vitamin D3) daily for 3 days. Patients with corrected calcium level (calcium level based on the serum albumin level) > 2.60 mmol/L were excluded from phase II (and phase III), in order to avoid hypercalcemia. Substitution resulted in an increase in vitamin D plasma levels from +/- 29.6 nmol/L to +/- 81.4 nmol/L (p < 0.0001), after +/- 14 days. However, vitamin D level remained below the desired threshold of 75 nmol/L in 29%. Therefore it was decided to increase the treatment period from 3 days to 7 days in the next 54 patients with a hip fracture in a prospective phase III (October 2011-January 2012). This time rapid substitution resulted in an increase from +/-31.4 nmol/L to +/-131.1 nmol/L (p < 0.0001), after +/- 16 days, and 100% of treated patients achieved plasma levels above the desired threshold of 75 nmol/L.
  
  
  CONCLUSIONS
  virtually all patients with a hip fracture have low vitamin D plasma levels; substitution with 50,000 IU oral cholecalciferol daily for 7 days increases vitamin D plasma levels rapidly, safely and consistently.
authors.affiliation: Department of Orthopaedic Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK. de_jong_andy@yahoo.com
authors.forename: Andy
authors.initials: A
authors.lastname: de Jong
authors.affiliation: Department of Orthopaedic Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Woods
authors.affiliation: Department of Orthopaedic Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK.
authors.forename: Lise
authors.initials: L
authors.lastname: Van Gestel
authors.affiliation: Department of Orthopaedic Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK.
authors.forename: Mohanraj
authors.initials: M
authors.lastname: Suresh
authors.affiliation: Department of Orthopaedic Surgery, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Porteous
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D002762:Cholecalciferol / Q000008:administration & dosage*; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000097:blood / Q000150:complications*; D014808:Vitamin D Deficiency / Q000150:complications* / Q000188:drug therapy*
chemical_list: D050071:Bone Density Conservation Agents; D002762:Cholecalciferol