Extended physiotherapy and high-dose vitamin D show benefit effect on rate of falls and hospital re-admission after acute hip fracture

Supplementation with 2,000 IU vitamin D per day in combination with extended PT appears to be beneficial in optimizing post-hip-fracture care, a new study suggests.

The trial enrolled 173 acute hip fracture patients (79% women; mean age 84 years) (1). 51% of the patients had severe vitamin D deficiency with serum 25-hydroxyvitamin D (25-(OH)D) below 30 nmol/l, 98% had serum 25-(OH)D levels below 75 nmol/l. 212 falls with a rate of 1.43 falls per observed patient-year and 74 hospital re-admissions with a rate of 0.5 per observed patient-year were documented.

Extended physiotherapy reduced the rate of falls significantly by 25% over 12 months follow-up. 2,000 IU versus 800 IU vitamin D per day reduced the rate of hospital re-admissions significantly by 39%. This could be explained by a significant 60% reduction in fall-related injuries and a significant 90% reduction in infections leading to inpatient care.

Fractures are among the most prevalent fall injuries. In the U.S., each year between 360,000 and 480,000 older adults sustain fall-related fractures. Hip fracture is known to impair the function of elderly patients considerably in the short term, but here is only limited information of the potential permanence of this impairment. The goal of treatment is to restore the patient's pre-fracture lifestyle. In this respect, intensive rehabilitation has been recommended and applied in many institutions.

Osteoporosis, a metabolic disease that causes bones to become brittle, greatly increases the chances that a fracture will result from a fall. Osteoporosis is most often associated with inadequate calcium intake, but insufficient vitamin D contributes to osteoporosis by reducing calcium absorption. It was observed that serum vitamin D (25-(OH)D) levels decrease with age, and that adequate vitamin D intake can help preventing osteoporosis in older adults.

1. Bischoff-Ferrari H. et al. Effect of extended physiotherapy and high-dose vitamin D on rate of falls and hospital re-admission after acute hip fracture: a randomized controlled trial. American Society for Bone and Mineral Research, 2009.