title: Positive Effects of a Sufficient Pre-fracture Serum Vitamin D Level on the Long-Term Survival of Hip Fracture Patients in Finland: A Minimum 11-Year Follow-Up.
abstract: BACKGROUND
  Several studies have shown that the mortality of elderly hip fracture patients is higher than that in the general population, and is higher in male than in female hip fracture patients.
  
  
  OBJECTIVE
  The objective of this study was to investigate factors affecting overall mortality at a minimum of 11 years following a new hip fracture.
  
  
  METHODS
  The sex, age, pre-fracture serum 25-hydroxyvitamin D level, American Society of Anesthesiologists physical status classification (ASA class), 1- to 12-month mortality, and 2- to 11-year mortality of hip fracture patients were collected. The use of anti-osteoporotic medication and prescribed calcium and vitamin D supplements during the first 3 post-operative years were checked. The survival of the patients was analyzed using both the Bayesian multivariate analysis and the life table method.
  
  
  RESULTS
  The mean age of females at the time of the index hip fracture was 80.5 years and of males was 73 years. The protective factors were age <80 years; ASA class 1-2; serum 25-hydroxyvitamin level ≥ 50 nmol/L; post-fracture use of calcium and vitamin D supplementation; post-fracture concomitant use of calcium and vitamin D supplementation and anti-osteoporotic drugs; and male sex. The excess mortality was higher among women than men. Survival was highest among patients with a vitamin D level of ≥ 50 nmol/L. Post-fracture concomitant use of calcium and vitamin D and anti-osteoporotic drugs was positively associated with survival.
  
  
  CONCLUSIONS
  Our results indicate a positive relationship between a sufficient pre-fracture vitamin D serum concentration (≥ 50 nmol/L) and survival, and a potential relationship between reduced mortality and the concomitant post-fracture use of prescribed calcium plus vitamin D supplementation and anti-osteoporotic medication.
authors.affiliation: Department of Public Health, Hjelt Institute, University of Helsinki, PO Box 41, 00014, Helsinki, Finland, ilona.nurmi@pp.inet.fi.
authors.forename: Ilona
authors.initials: I
authors.lastname: Nurmi-Lüthje
authors.forename: Peter
authors.initials: P
authors.lastname: Lüthje
authors.forename: Juha-Pekka
authors.initials: JP
authors.lastname: Kaukonen
authors.forename: Matti
authors.initials: M
authors.lastname: Kataja
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D002136:Calcium, Dietary / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000097:blood / Q000188:drug therapy; D012737:Sex Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000473:pathology
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D; C104450:25-hydroxyvitamin D