Correlation of Fragility Fractures of Hip with Vitamin D Levels


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.

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