Vitamin D and Calcium Supplementation in Elderly Patients Suffering Fragility Fractures; The Road not Taken.

Background: Calcium and Vitamin D supplementation in elderly patients may decrease the risk of hip fracture by up to one-third. Many patients suffering fragility fractures do not go on to receive this treatment despite clear recommendations from the National Institute for Health and Clinical Excellence (NICE). The aim of this study was to audit the proportion of patients admitted with a hip fracture who had suffered a previous fragility fracture and were taking calcium and vitamin D supplements, with the standard being that all of these patients should have been taking bone protection. We also aimed to assess the Vitamin D levels of patients admitted with a hip fracture to our unit.

Methods: Patients were prospectively added to a database over a 12-month period. Serum vitamin D levels (25-OH D3) were measured on admission and case-notes were reviewed for pre-injury social function and mobility.

Results: 147 patients were included in the study. Median age was 85 years (Interquartile range 79 - 90 (Range 53 - 100 years)). Only eighteen patients (11.4%) were taking calcium and vitamin D supplementation on admission. Forty seven patients (29%) had documented evidence of a previous fragility fracture within the last seven years. Only fourteen of these patients (19%) were receiving calcium and vitamin D supplementation. One hundred and twenty two patients were deficient in Vitamin D (76%). Twenty five patients (16%) had insufficient Vitamin D. Only the remaining 14 patients (8%) had sufficient vitamin D.

Conclusion: Vitamin D deficiency is endemic amongst patients suffering hip fractures. Very few patients who had suffered a previous fragility fracture were taking Calcium and Vitamin D supplements when admitted with a hip fracture several years later. This is an opportunity missed.