A Randomised, Controlled Comparison of Vitamin D Strategies is Acute Hip Fracture Patients
A Randomised, Controlled Comparison of Vitamin D Strategies is Acute Hip Fracture Patients
The purpose of the study is to determine the best dose of Vitamin D to give to hip fracture
 patients to achieve the optimal therapeutic level.
Low Vitamin D levels can cause faster bone loss and increase the risk of having a fracture.
 Patients who experience a hip fracture have low levels of Vitamin D. It is not clear how much
 Vitamin D must be taken in order to reach this optimal level.

 Serum 25-hydroxyvitamin D3 (25-OHD) concentrations are the recognized functional status
 indicator for vitamin D. Although there is no clear consensus, vitamin D 'insufficiency' has
 been considered in the range of 25- 75/80 nmol/L. Patients with acute hip fracture are at
 high risk for a recurrent hip fracture or other fragility fractures (and falls) and are a
 group who should be targeted for osteoporosis treatment (i.e. Bisphosphonate or other
 antiresorptive). Before fracture patients start on a bisphosphonate, however, an important
 consideration is whether 25-OHD levels are at a therapeutic level (>75 nmol/l and less than
 150-200 nmol/L). Case-control studies indicate that older people who experience a hip
 fracture have lower serum concentrations of 25-OHD than do those without a fracture. In
 cross-sectional studies, the majority of patients with hip fracture are considered to have
 insufficient vitamin D levels. Although the benefits of supplementing patients with at least
 800 to 1000 IU/day Vitamin D3 may be recognized, there is little information available to
 guide physicians regarding the appropriate management of hip fracture patients who may be
 severely Vitamin D deficient, particularly in acute hip fracture patients. Few studies have
 examined whether high dose vitamin D (i.e. 50,000 IU or greater/week) offers an advantage
 over smaller, routinely prescribed doses (i.e. 800 or 1000 IU), particularly in hip fracture
 patients.

 The purpose of this study is to determine the number of hip fracture patients reaching an
 optimal level of vitamin D comparing between three different Vitamin D dose strategies:

 A. 50,000 D2 oral bolus followed by 800 IU D3 daily B. 100,000 D2 oral bolus followed by 800
 IU D3 daily C. 800 IU D3 daily

 The Vitamin D strategies will be administered over 3-months in acute hip fracture patients.
 The proportion of patients reaching an optimal level of 25-OHD (>75 nmol/L) will be
 determined.

 Secondary measures include the Timed Up and Go test, and 2 Minute Walk Test to compare the
 effects of the Vitamin D supplementation strategies on functional and muscle strength scales.
Inclusion Criteria:

 -  Fragility hip fracture patient

 -  Previous Vitamin D supplementation is okay.

 Exclusion Criteria:

 -  Patients with pathological fracture secondary to malignancy or intrinsic bone disease
 (eg. Paget's disease)

 -  Cancer in the past 10 years likely to metastasize to bone

 -  Renal insufficiency (creatinine <30 mls/min)

 -  Hypercalcemia (primary hyperparathyroidism; granulomatous diseases; drug-induced such
 as lithium, thiazides), hypocalcemia, hypercalciuria, fracture or stroke within the
 last 3 months

 -  Hormone replacement therapy, calcitonin, fluoride, or bisphosphonates during the
 previous 24 months

 -  Pre-existing bone abnormality

 -  Renal stones in past 10 years