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
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.