Vitamin D and nutritional supplements in the revalidation of older people after hip surgery

Introduction. - Hypovitaminosis D is common in older people. Low vitamin D may contribute to hip fracture risk. Methods. - During a 15-week period all people admitted for revalidation after hip surgery (elective or after fracture) were screened for hypovitaminosis D. A standard substitution was given consisting of 100,000 IU vitamin D at day 1 followed by calcium/vit D 1000/880 once daily together with a high caloric nutritional supplement. Vitamin D, PTH and nutritional parameters were measured at baseline and at follow-up. Results. - One hundred and three patients were enrolled (78% women, mean age 82.1 +/- 6.2 years) of which 82% were treated for hip fracture. In the fracture group there is a significantly higher prevalence of osteoporosis (63.9% versus 20.0%; p <= 0.005). Vitamin D insufficiency (< 30 ng/ml) is extremely prevalent in both groups (94.2% versus 92.8%) with levels below 15 ng/ml in respectively 35.3% and 53.0% for the elective and the fracture group. Highest values of PTH were seen in people with the lowest levels of vitamin D. After intervention there is a significant rise in serum vitamin D (15.6-26.3 ng/ml; p <= 0.001) and a significant reduction in plasma PTH (40.2-32.1 pg/ml; p <= 0.001). Conclusion. - A majority of patients after hip surgery has vitamin D deficiency. People with traumatic fracture were significantly more osteoporotic. By implementing standard vitamin D and caloric supplementation in the revalidation after hip surgery PTH levels are significantly lowered and nutritional parameters improve. (C) 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.