24-25-dihydroxyvitamin-d-3 and Hip-Fractures

Hip fracture rates are increasing worldwide, and the risk for a second hip fracture is high. The decision to administer antiresorptive treatment is based mainly on bone mineral density and/or a history of previous osteoporotic fractures.. To evaluate the contribution of BMD, previous fractures, clinical and laboratory parameters to hip fracture risk assessment.. The study population included 113 consecutive hip fracture patients, aged 72.5 +/- 9.4 years, discharged from the orthopedic surgery department. BMD was assessed at the lumbar spine, femoral neck and total hip. The results were expressed in standard deviation scores as T-scores--compared to young adults and Z-scores--compared to age-matched controls. Plasma or serum levels of parathyroid hormone, 25-hydroxyvitamin 3 and urinary deoxypyridinoline cross-links were evaluated.. We observed T-scores < or = 2.5 in 43 patients (45.3%) at the lumbar spine, in 47 (52.2%) at the femoral neck and in 33 (38%) at the total hip. Twenty-eight patients (29.5%) had neither low BMD nor previous osteoporotic fractures. Using a T-score cutoff point of (-1.5) at any measurement site would put 25 (89%) of these patients into the high fracture risk group. Mean DPD level was 15.9 +/- 5.8 ng/mg (normal 4-7.3 ng/mg creatinine). Vitamin D inadequacy was observed in 99% of patients.. Using current criteria, about one-third of elderly hip fracture patients might not have been diagnosed as being at risk. Lowering the BMD cutoff point for patients with additional risk factors may improve risk prediction yield.

Topics: 24,25-Dihydroxyvitamin D 3; Absorptiometry, Photon; Aged; Aged, 80 and over; Amino Acids; Bone Density; Female; Hip Fractures; Humans; Male; Parathyroid Hormone; Risk Assessment; Risk Factors

To assess the correlation between osteoid and vitamin D in patients with a proximal femoral fracture, bone biopsies of the fracture site and the iliac crest were studied; and vitamin-D levels were measured in fasting blood taken on the day of admission. No osteomalacia was found at either site in any of the 95 patients investigated. In 65/95 patients, levels of 25-hydroxy-vitamin D (25-OHD) and 24,25-dihydroxy-vitamin D (24, 25-OH2D) were within the normal range, whereas 30/95 patients were deficient. Because there was no correlation between the amount of osteoid and vitamin-D metabolites in our patients, we concluded that osteomalacia was not a contributory factor in the pathogenesis of the hip fracture.

Topics: 24,25-Dihydroxyvitamin D 3; Aged; Aged, 80 and over; Biopsy; Evaluation Studies as Topic; Female; Femur Neck; Hip Fractures; Humans; Ilium; Male; Middle Aged; Osteomalacia; Vitamin D; Vitamin D Deficiency