Recommends vitamin D after hip fracture ( but not enough and no-bone building co-factors) – May 2021

How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture?

Osteoporos Int . 2021 May 20. doi: 10.1007/s00198-021-05957-9
T Chevalley 1, M L Brandi 2, E Cavalier 3, N C Harvey 4, G Iolascon 5, C Cooper 4 6, D Hannouche 7, J-F Kaux 8, A Kurth 9, S Maggi 10, G Maier 11, K Papavasiliou 12, N Al-Daghri 13, M Sosa-Henríquez 14 15, N Suhm 16, U Tarantino 17, J-Y Reginster 18, R Rizzoli 19

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Table of contents

In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency ( 25 (OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL) ) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.