25-hydroxyvitamin-d-2 and Femoral-Neck-Fractures

59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome was significantly better in the supplemented group (56% favourable course vs 13% in controls) during the stay in the convalescent hospital. The rates of complications and deaths were also significantly lower in supplemented patients (44% vs 87%). 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients (40% vs 74%). The median duration of hospital stay was significantly shorter in the supplemented group (24 vs 40 days). Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.

Topics: 25-Hydroxyvitamin D 2; Accidental Falls; Administration, Oral; Aged; Aged, 80 and over; Dietary Proteins; Energy Intake; Energy Metabolism; Evaluation Studies as Topic; Female; Femoral Neck Fractures; Food, Fortified; Humans; Male; Middle Aged; Nutrition Disorders; Nutritional Status; Prospective Studies; Randomized Controlled Trials as Topic; Risk Factors

Calcium (Ca) metabolism, with particular reference to serum vitamin D metabolites, was investigated in 40 women with femoral neck fracture (mean age 77.1 +/- 8.6 yr). All the patients were ambulant before the fracture; eight were long-term geriatric in-patients. Serum total and ionised calcium and serum albumin levels were significantly lower, and serum parathormone (PTH) levels significantly higher in fracture patients than in controls. Both serum 25-OH-D and 1,25-(OH)2D were significantly lower in fracture patients than in controls. We concluded that vitamin D, serum PTH and calcium levels should be checked with greater frequency in patients at high risk for osteoporosis and osteomalacia before they reach the age of 70.

Topics: 25-Hydroxyvitamin D 2; Aged; Aged, 80 and over; Calcium; Ergocalciferols; Female; Femoral Neck Fractures; Humans; Parathyroid Hormone; Serum Albumin

In a previous study we observed lower serum concentrations of 25(OH)D, 24,25(OH)2D, and 1,25(OH)2D in patients with hip fracture than in aged control subjects. In order to evaluate the effect of trauma on vitamin D metabolite levels, we measured serum concentrations of vitamin D binding protein (DBP) in 118 patients with hip fracture and 71 aged control subjects. Serum DBP was lower in the patients than in the controls (mean +/- SD 315 +/- 60 vs 371 +/- 44 mg/l, P less than 0.001). Serum DBP correlated positively with serum total protein, albumin, alpha 2-globulin, and the vitamin D metabolite levels in the patients. When correcting for differences in serum DBP, serum 25(OH)D and 24,25(OH)2D still were significantly lower in patients than in controls, whereas serum 1,25(OH)2D was not. The free 1,25(OH)2D index (10(5) x molar ratio 1,25(OH)2D/DBP) was lower in patients than in controls, but the level of significance was marginal. This difference was not significant when patients and controls with impairment of renal function were excluded. It is concluded that the difference in serum 25(OH)D and 24,25(OH)2D between patients and controls is largely preexistent. However, the lower serum 1,25(OH)2D in the patients is mainly caused by the trauma. The free 1,25(OH)2D concentrations are almost similar in the two groups when renal function is normal.

Topics: 25-Hydroxyvitamin D 2; Aged; Alpha-Globulins; Calcifediol; Ergocalciferols; Femoral Neck Fractures; Hip Fractures; Humans; Hydroxycholecalciferols; Serum Albumin; Vitamin D; Vitamin D-Binding Protein

Serum concentrations of 25-hydroxyvitamin D (25-OHD), 24,25-dihydroxyvitamin D [24,25(OH)2D] and immunoreactive parathyroid hormone (PTH) were determined in elderly patients with fracture of the femoral neck and in age-matched controls during summer, winter and early spring in southern Finland. The expected seasonal variation in 25-OHD values was observed in both patients and controls, though the patient group had significantly lower values during winter (P less than 0.02) and spring (P less than 0.01). The 24,25(OH)2D:25-OHD ratio remained constant in both patients and controls throughout the study. A significant negative correlation between PTH and 25-OHD values was found in the patient group. Thus, vitamin D deficiency may contribute to the high incidence of femoral neck fractures in elderly people, and the increased PTH activity, observed in many patients with these fractures, is secondary to vitamin D deficiency.

Topics: 24,25-Dihydroxyvitamin D 3; 25-Hydroxyvitamin D 2; Age Factors; Aged; Dihydroxycholecalciferols; Ergocalciferols; Femoral Neck Fractures; Humans; Middle Aged; Parathyroid Hormone; Seasons