From the Department of Orthopaedic Surgery and Rehabilitation Medicine ,UChicago Medicine, Chicago, IL(Liu, Mirle, Lee, Hynes, and Strelzow), and the Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX (Dirschl).
J Am Acad Orthop Surg. 2024 May 15;32(10):464-471. doi: 10.5435/JAAOS-D-23-00932. Epub 2024 Mar 13.
Vitamin D plays a critical role in bone health, affecting bone mineral density and fracture healing. Insufficient serum vitamin D levels are associated with increased fracture rates. Despite guidelines advocating vitamin D supplementation, little is known about the prescription rates after fragility fractures. This study aims to characterize vitamin D prescription rates after three common fragility fractures in patients older than 50 years and explore potential factors influencing prescription rates.
The study used the PearlDiver Database, identifying patients older than 50 years with hip fractures, spinal compression fractures, or distal radius fractures between 2010 and 2020. Patient demographics, comorbidities, and vitamin D prescription rates were analyzed. Statistical methods included chi-square analysis and univariate and multivariable analyses.
A total of 3,214,294 patients with fragility fractures were included. Vitamin D prescriptions increased from 2.50% to nearly 6% for all fracture types from 2010 to 2020. Regional variations existed, with the Midwest having the highest prescription rate (4.25%) and the West the lowest (3.31%). Patients with comorbidities such as diabetes, tobacco use, obesity, female sex, age older than 60 years, and osteoporosis were more likely to receive vitamin D prescriptions.
Despite a notable increase in vitamin D prescriptions after fragility fractures, the absolute rates remain low. Patient comorbidities influenced prescription rates, perhaps indicating growing awareness of the link between vitamin D deficiency and these conditions. However, individuals older than 60 years, a high-risk group, were markedly less likely to receive prescriptions, possibly because of practice variations and concerns about polypharmacy. Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fractures. However, there is a need to raise awareness about the importance of vitamin D for bone health, particularly in older adults, and additional study variations in prescription practices. These findings emphasize the importance of enhancing post-fracture care to reduce morbidity and mortality associated with fragility fractures.
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维生素 D 在骨骼健康中起着至关重要的作用，影响着骨矿物质密度和骨折愈合。血清维生素 D 水平不足与骨折发生率增加有关。尽管指南提倡补充维生素 D，但对于脆性骨折后维生素 D 的处方率知之甚少。本研究旨在描述 50 岁以上患者发生三种常见脆性骨折后维生素 D 的处方率，并探讨影响处方率的潜在因素。
本研究使用 PearlDiver 数据库，确定了 2010 年至 2020 年期间年龄在 50 岁以上的髋部骨折、脊柱压缩性骨折或桡骨远端骨折患者。分析了患者的人口统计学特征、合并症和维生素 D 的处方率。统计方法包括卡方检验以及单变量和多变量分析。
共纳入 3214294 例脆性骨折患者。从 2010 年到 2020 年，所有骨折类型的维生素 D 处方率从 2.50%增加到近 6%。存在地域差异，中西部地区的处方率最高（4.25%），而西部地区最低（3.31%）。患有合并症的患者，如糖尿病、吸烟、肥胖、女性、年龄大于 60 岁和骨质疏松症，更有可能接受维生素 D 处方。
尽管脆性骨折后维生素 D 的处方显著增加，但绝对比例仍然较低。患者的合并症影响了处方率，这可能表明人们对维生素 D 缺乏与这些疾病之间的联系的认识不断提高。然而，年龄大于 60 岁的高风险人群接受处方的可能性明显较低，这可能是由于实践差异和对多药治疗的担忧。教育计划和修订后的指南可能提高了脆性骨折后维生素 D 的处方率。然而，仍需提高人们对维生素 D 对骨骼健康重要性的认识，特别是在老年人中，并进一步研究处方实践的差异。这些发现强调了加强骨折后护理的重要性，以降低脆性骨折相关的发病率和死亡率。
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