Physiotherapy and vitamin D benefit post-hip-fracture care

Extended physiotherapy and vitamin D supplementation may help to decrease the likelihood of falling and re-admission to hospital after acute hip fracture, says a new study.

In the randomized controlled trial, 173 acute hip fracture patients (79% women; mean age 84 years) were randomly assigned to receive extended physiotherapy (supervised 60 min per day during acute care plus unsupervised home program), standard physiotherapy (supervised 30 minutes per day during acute care and no home program) or vitamin D (2,000 IU vs. 800 IU cholecalciferol per day) therapy (1). During a 12-month follow-up the rate of falls and hospital re-admissions was measured. The results showed that extended physiotherapy reduced the rate of falls significantly by 25% compared to the standard physiotherapy. The supplementation with 2,000 IU vitamin D did significantly reduce the rate of hospital re-admissions by 39% compared with 800 IU but did not reduce the rate of falls.

The researchers commented that they expected vitamin D supplementation to reduce the overall rate of falls, as shown in several randomized trials. A possible explanation may be that most of the benefit of vitamin D on muscle strength and fall prevention is achieved at a dose of 800 IU per day, they said. Alternatively, the frailty of the post-hip-fracture patients in this study was greater than in other trials, which may have overridden the benefit of vitamin D. The reduced rate of hospital re-admissions could be explained by a significant 60% reduction in fall-related injuries and a significant 90% reduction in infections leading to inpatient care.

The scientists concluded that extended physiotherapy and supplementation with 2,000 IU vitamin D per day have complementary benefits on the rate of falls and hospital re-admission after acute hip fracture. Both strategies together appear to be beneficial in optimizing post-hip-fracture care.

A new position statement of the International Osteoporosis Foundation recommends that vitamin D intakes for older adults should be increased to 1,000 IU per day in order to ensure bone health and help reduce the risk of falls (2).

1.  Bischoff-Ferrari H. et al. Effect of high-dosage cholecalciferol and extended physiotherapy and on complications after hip fracture: a randomized controlled trial. Arch Intern Med. 2010; 170(9):813–820.
2. Dawson-Hughes B. et al. IOF position statement: vitamin D recommendations for older adults. Osteoporosis International. 2010.