Vitamin D deficiency in hip fracture patients associated with increased mortality: study

John M. Bayram et al conducted a study to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture. The study was conducted at Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK.

Vitamin D deficiency is defined by the Endocrine Society Task Force as a serum 25-hydroxyvitamin D [25(OH)D] level < 50 nmol/l.

A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality.

Key findings of the study were:

• The cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l).

• The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022).

• Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk.

• Vitamin D deficiency was not associated with length of hospital stay.

The authors opined – “In conclusion, there was an independent association between vitamin D deficiency and increased mortality in hip fracture patients. These results agree with the wider literature, but the independence from confounders may be due to lack of inclusion of a comprehensive measure of comorbidity in this study. The role of routinely measuring vitamin D status in this population is debated. While some consider it mandatory, others, like the Scottish Hip Fracture Audit (SHFA), consider vitamin D deficiency so prevalent that measurement is unnecessary and treat all hip fracture patients for vitamin D deficiency. Ensuring hip fracture patients receive vitamin D supplementation during their hospital stay remains important given its high prevalence and the increased mortality, falls and fracture risks linked to vitamin D deficiency.” 

Further reading:

Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk. John M. Bayram et al European Journal of Orthopaedic Surgery & Traumatology (2024) 35:33 https://doi.org/10.1007/s00590-024-04162-8