Vitamin D loading dose after hip fracture surgery was great – RCT

Created August 2016

An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial

BMC Musculoskeletal Disorders DOI: 10.1186/s12891-016-1174-9

Jenson CS Mak, Rebecca S. Mason, Linda Klein and Ian D. Cameron

800 IU daily and 500 mg Calcium for everyoneLoading dose of 250,000 IU for people assigned to active replacementFar fewer falls in those getting loading doseWould have been better if 1. Had higher level of vitamin D years before - so as to no have hip fracture in the first place1. Had used larger loading dose and larger maintenance dose, along with cofactors needed to build bones* Say 400,000 IU loading and 4,000 IU maintenanceSee also Vitamin D Life* Overview Fractures and vitamin D* Healthy bones need: Calcium, Vitamin D, Magnesium, Silicon, Vitamin K, and Boron – 2012* Partial (proximal) hip fracture strongly associated with low Vitamin D – Aug 2016* Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016* Hip fracture outcome 5X more likely to be poor if low vitamin D – Jan 2015* Delirium 2.7 X more likely after hip fracture and low vitamin D – May 2015The TOP articles in Falls/Fractures and Vitamin D are listed here: {category}Pages listed in BOTH the categories Falls/Fracture and Meta-analysis{category}Falls/Fracture Intervention trials (give Vitamin D and see what happens){category}

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Background

Improving vitamin D (25-OHD) status may be an important modifiable factor that could reduce disability severity, fall-rates and mortality associated after hip fracture surgery. Providing a loading-dose post-surgery may overcome limitations in adherence to daily supplementation.

Method

In this randomized, double-blind, placebo-controlled trial, 218 adults, aged 65-years or older, requiring hip fracture surgery were assigned to receive a single loading-dose of cholecalciferol (250,000 IU vitamin-D3, the REVITAHIP - Replenishment of Vitamin D in Hip Fracture strategy) or placebo, both receiving daily vitamin-D(800 IU) and calcium (500 mg) for 26-weeks. Outcome measures were 2.4 m gait-velocity, falls, fractures, death (Week-4), 25-OHD levels, quality-of-life measure (EuroQoL) and mortality at weeks-2, 4 and 26.

Results

Mean age of 218 participants was 83.9(7.2) years and 77.1 % were women. Baseline mean 25-OHD was 52.7(23.5)nmol/L, with higher levels at Week-2 (73 vs 66 nmol/L; p = .019) and Week-4 (83 vs 75 nmol/L; p = .030) in the Active-group, but not at Week-26. At week-4, there were no differences in 2.4 m gait-velocity (0.42 m/s vs 0.39 m/s, p = .490), fractures (2.7 % vs 2.8 %, p = .964) but Active participants reported less falls (6.3 % vs 21.1 %, 2 = 4.327; p = 0.024), with no significant reduction in deaths at week-4 (1 vs 3, p = 0.295), higher percentage reporting ‘no pain or discomfort’ (96.4 % vs 88.8 %, p = 0.037), and trended for higher EuroQoL-scores (p = 0.092) at week-26. One case of hypercalcemia at week-2 normalised by week-4.

Conclusion

Among older people after hip fracture surgery, the REVITAHIP strategy is a safe and low cost method of improving vitamin-D levels, reducing falls and pain levels.

Trial registration

The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066 (Date of registration: 14/05/2010).