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

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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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