title: Economic Benefit of Calcium and Vitamin D Supplementation: Does It Outweigh the Cost of Nonunions?
abstract: OBJECTIVE
  The purpose was to evaluate economic benefit of calcium and vitamin D supplementation in orthopaedic trauma patients. We hypothesized that reduced nonunion rates could justify the cost of supplementing every orthopaedic trauma patient.
  
  
  METHODS
  Retrospective, economic model.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Adult patients over 3 consecutive years presenting with acute fracture.
  
  
  METHODS
  Operative or nonoperative fracture management.
  
  
  METHODS
  Electronic medical records were queried for ICD-9 code for diagnosis of nonunion and for treatment records of nonunion for fractures initially treated within our institution.
  
  
  RESULTS
  In our hospital, a mean of 92 (3.9%) fractures develop nonunion annually. A 5% reduction in nonunion risk from 8 weeks of vitamin D supplementation would result in 4.6 fewer nonunions per year. The mean estimate of cost for nonunion care is $16,941. Thus, the projected reduction in nonunions after supplementation with vitamin D and calcium would save $78,030 in treatment costs per year. The resulting savings outweigh the $12,164 cost of supplementing all fracture patients during the first 8 weeks of fracture healing resulting in a net savings of $65,866 per year.
  
  
  CONCLUSIONS
  Vitamin D and calcium supplementation of orthopaedic trauma patients for 8 weeks after fracture seems to be cost effective. Supplementation may also reduce the number of subsequent fractures, enhance muscular strength, improve balance in the elderly, elevate mood leading to higher functional outcome scores, and diminish hospital tort liability by reducing the number of nonunions.
  
  
  METHODS
  Economic Level V. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, affiliated with Case Western Reserve University.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Childs
authors.forename: Brendan A
authors.initials: BA
authors.lastname: Andres
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000191:economics*; D002118:Calcium / Q000008:administration & dosage / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics; D019587:Dietary Supplements / Q000191:economics*; D005260:Female; D017759:Fractures, Malunited / Q000191:economics* / Q000517:prevention & control*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage / Q000191:economics; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium