Authors :
Dr. Aakash Lengde; Dr. Deepak Hegde; Dr. Kingshuk Ganguly
Volume/Issue :
Volume 8 - 2023, Issue 3 - March
Google Scholar :
https://bit.ly/3TmGbDi
Scribd :
https://bit.ly/3LMQWNn
DOI :
https://doi.org/10.5281/zenodo.7765273
Abstract :
Vitamin D plays a role in optimization of the skeletal
function. Vitamin D helps in calcium homeostasis which
further helps in bone mineralization and preventing
osteomalacia, hence older individuals with low vitamin D
levels (<30ng/ml) must be prone to fragility fractures of
the hip.
Methodology
Study design – Prospective observational study.
Study population Patients at Justice K. S. Hegde
Charitable Hospital with closed fractures of the hip
involving the proximal femur diagnosed by a physical
examination and plain radiography in the pelvis with
both hips Anteroposterior View(AP) and lateral view
of the involved hip.
Study setting - Justice K. S. Hegde Charitable Hospital
attached to K. S. Hegde Medical Academy, a unit of
Nitte (Deemed to be University), Deralakatte,
Mangaluru – 575018 (Hospital-based study).
Study Duration - Study was conducted from February
2021 till October 2022.
Sample size – Sample size was calculated using
nMaster software (version 2.0). Based on the alpha
level of 5% SD of vitamin D in hip fragility fractures
is 8.05(12), for the estimation error of 1.5, sample size
was decided as 111. This was calculated using master
version 2 software.
Methods
All patients over 45 with hip fractures from minor
trauma, such as a slip and fall while standing or walking,
were clinically and radiologically assessed. A patient
history and injury information were documented using a
predesigned proforma. The history consists of
accidents/trauma, fractures in the past, surgeries,
drug/supplement use history, and co-morbid conditions.
The pelvis and affected limb were radiographed. Boyd
and Griffin for intertrochanteric fractures and Garden
for neck of femur fractures, Russel-Taylor classification
for Subtrochanteric fracture to classify the kind,
comminution pattern, and grade of fracture. A biochemist
evaluated 25-hydroxyvitamin D (25-OH Vit.D) levels in
venous blood samples taken after admission. Our
laboratory tested serum vitamin D levels using
electrochemiluminescence Immuno Assay (ECLIA) on an
automated analyzer.
Vitamin D values <20ng/ml were judged inadequate,
while 20–20ng/ml were considered insufficient. 30-
100mg/ml vitamin D was typical. Finally, vitamin-D levels
correlated with fracture comminution. Data Analysis: On
statistical analysis, the data was expressed in mean SD,
frequency & percentage. Chi-square test was used for the
analysis of the data. RESULTS In the present study, 111
patients were evaluated with X-ray radiographs to
investigate the comminution pattern of hip fractures and
the presence of hypovitaminosis D in patients diagnosed
with hip fractures. The mean age of patients was 70.40 ±
11.29 years. Out of 111 patients, 19 patients (17%)
belonged to the age group of 46 to 60 years, 60 patients
(53.6%) belonged to the age 61 to 75 years. 33 patients
(29.5%) belonged to the age group of >75 years. Out of
111 patients, patients (71.4%) were females and 32
patients (28.6%) were males. Based on symptoms, 45
patients (40.17%) presented with left Hip/Groin pain with
inability to bear weight and 66 patients (59.82%)
presented with right Hip/Groin pain with inability to bear
weight. Based on comminution, 59 patients (52.7%) had
comminution. The mean vitamin D levels was 20.98 ±
13.11. 46 (41.1%) of the 111 patients had deficiency
20ng/dL, 4 (3.6%) had insufficient 21-29ng/dL, 6 (5.4%)
had optimal 40-60ng/dL, and 3 (2.7%) had sufficient 30-
39ng/dL. The correlation between comminution and
Holick's classification was statistically significant.
(p=0.001). The findings of the study conclude that
Vitamin D have a significant effect on the presence of
comminution and fracture site pattern.
Conclusion
According to our study, osteoporosis, vitamin D
deficiency, and fracture site comminution are all
coexisting conditions. Early identification and treatment
with vitamin D for osteomalacia and anti-osteoporotic
regimens for osteoporosis will enhance bone, muscle, and
general health, reducing falls and the associated fractures.
Incorporating findings from bigger research into Indian
hip fracture prevention recommendations is necessary.
Vitamin D plays a role in optimization of the skeletal
function. Vitamin D helps in calcium homeostasis which
further helps in bone mineralization and preventing
osteomalacia, hence older individuals with low vitamin D
levels (<30ng/ml) must be prone to fragility fractures of
the hip.
Methodology
Study design – Prospective observational study.
Study population Patients at Justice K. S. Hegde
Charitable Hospital with closed fractures of the hip
involving the proximal femur diagnosed by a physical
examination and plain radiography in the pelvis with
both hips Anteroposterior View(AP) and lateral view
of the involved hip.
Study setting - Justice K. S. Hegde Charitable Hospital
attached to K. S. Hegde Medical Academy, a unit of
Nitte (Deemed to be University), Deralakatte,
Mangaluru – 575018 (Hospital-based study).
Study Duration - Study was conducted from February
2021 till October 2022.
Sample size – Sample size was calculated using
nMaster software (version 2.0). Based on the alpha
level of 5% SD of vitamin D in hip fragility fractures
is 8.05(12), for the estimation error of 1.5, sample size
was decided as 111. This was calculated using master
version 2 software.
Methods
All patients over 45 with hip fractures from minor
trauma, such as a slip and fall while standing or walking,
were clinically and radiologically assessed. A patient
history and injury information were documented using a
predesigned proforma. The history consists of
accidents/trauma, fractures in the past, surgeries,
drug/supplement use history, and co-morbid conditions.
The pelvis and affected limb were radiographed. Boyd
and Griffin for intertrochanteric fractures and Garden
for neck of femur fractures, Russel-Taylor classification
for Subtrochanteric fracture to classify the kind,
comminution pattern, and grade of fracture. A biochemist
evaluated 25-hydroxyvitamin D (25-OH Vit.D) levels in
venous blood samples taken after admission. Our
laboratory tested serum vitamin D levels using
electrochemiluminescence Immuno Assay (ECLIA) on an
automated analyzer.
Vitamin D values <20ng/ml were judged inadequate,
while 20–20ng/ml were considered insufficient. 30-
100mg/ml vitamin D was typical. Finally, vitamin-D levels
correlated with fracture comminution. Data Analysis: On
statistical analysis, the data was expressed in mean SD,
frequency & percentage. Chi-square test was used for the
analysis of the data. RESULTS In the present study, 111
patients were evaluated with X-ray radiographs to
investigate the comminution pattern of hip fractures and
the presence of hypovitaminosis D in patients diagnosed
with hip fractures. The mean age of patients was 70.40 ±
11.29 years. Out of 111 patients, 19 patients (17%)
belonged to the age group of 46 to 60 years, 60 patients
(53.6%) belonged to the age 61 to 75 years. 33 patients
(29.5%) belonged to the age group of >75 years. Out of
111 patients, patients (71.4%) were females and 32
patients (28.6%) were males. Based on symptoms, 45
patients (40.17%) presented with left Hip/Groin pain with
inability to bear weight and 66 patients (59.82%)
presented with right Hip/Groin pain with inability to bear
weight. Based on comminution, 59 patients (52.7%) had
comminution. The mean vitamin D levels was 20.98 ±
13.11. 46 (41.1%) of the 111 patients had deficiency
20ng/dL, 4 (3.6%) had insufficient 21-29ng/dL, 6 (5.4%)
had optimal 40-60ng/dL, and 3 (2.7%) had sufficient 30-
39ng/dL. The correlation between comminution and
Holick's classification was statistically significant.
(p=0.001). The findings of the study conclude that
Vitamin D have a significant effect on the presence of
comminution and fracture site pattern.
Conclusion
According to our study, osteoporosis, vitamin D
deficiency, and fracture site comminution are all
coexisting conditions. Early identification and treatment
with vitamin D for osteomalacia and anti-osteoporotic
regimens for osteoporosis will enhance bone, muscle, and
general health, reducing falls and the associated fractures.
Incorporating findings from bigger research into Indian
hip fracture prevention recommendations is necessary.
