Sprague Sheila, Madden Kim, Slobogean Gerard, Petrisor Brad, Adachi Jonathan D Rick, Bogoch Earl, Kleinlugtenbelt Ydo V, Bhandari Mohit
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):215-224. doi: 10.1177/2151458517735201. Epub 2017 Oct 25.
Introduction: Adequate calcium and vitamin D from diet and supplementation is recommended for elderly hip fracture patients. Using data from the multinational hip fracture arthroplasty trial (HEALTH), we determined the proportion of patients who consistently took vitamin D and calcium and which characteristics/prescribing practices were associated with consistency of supplement use.
HEALTH is a multicenter randomized trial of elderly hip fracture patients treated with hemi-arthroplasty and total hip arthroplasty. Patients were categorized as consistent users, inconsistent users, or nonusers of calcium and vitamin D. We used multinomial regression to determine the characteristics associated with calcium and vitamin D use.
603 HEALTH participants were included in the analysis. 34.7% of patients never took vitamin D within 12 months after surgery, 26.2% took vitamin D inconsistently, and 39.1% took vitamin D consistently. 36.0% of patients never took calcium within 12 months after surgery, 28.4% took calcium inconsistently, and 35.7% took calcium consistently. There was great variation in prescribed/recommended doses. Compared to nonusers, consistent users of the supplements were more likely to be female, North American, prescribed/recommended vitamin D and/or calcium postoperatively, and presented to a facility with comprehensive fragility fracture protocols.
A low proportion of elderly hip fracture patients are consistently taking vitamin D and calcium, which may contribute to poorer bone health. Surgeons should be educated to prescribe/ recommend vitamin D and calcium, institutions should develop comprehensive fragility fracture protocols and patient education strategies to ensure that patients with osteoporosis receive bone health management beyond fracture care.
建议老年髋部骨折患者从饮食和补充剂中获取充足的钙和维生素D。利用多国髋部骨折关节置换试验（HEALTH）的数据，我们确定了持续服用维生素D和钙的患者比例，以及哪些特征/处方习惯与补充剂使用的持续性相关。
HEALTH是一项针对接受半髋关节置换术和全髋关节置换术的老年髋部骨折患者的多中心随机试验。患者被分为钙和维生素D的持续使用者、非持续使用者或非使用者。我们使用多项回归来确定与钙和维生素D使用相关的特征。
603名HEALTH参与者被纳入分析。34.7%的患者在术后12个月内从未服用过维生素D，26.2%的患者服用维生素D不规律，39.1%的患者持续服用维生素D。36.0%的患者在术后12个月内从未服用过钙，28.4%的患者服用钙不规律，35.7%的患者持续服用钙。规定/推荐剂量存在很大差异。与非使用者相比，补充剂的持续使用者更可能为女性、北美洲人，术后被规定/推荐使用维生素D和/或钙，并在设有全面脆性骨折治疗方案的机构就诊。
持续服用维生素D和钙的老年髋部骨折患者比例较低，这可能导致骨骼健康状况较差。应教育外科医生开具/推荐维生素D和钙，机构应制定全面的脆性骨折治疗方案和患者教育策略，以确保骨质疏松患者在骨折治疗之外还能接受骨骼健康管理。
