Importance of vitamin D in hospital-based fracture care pathways |
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| Authors: | J Glowacki M S Leboff N S Kolatkar T S Thornhill M B Harris |
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| Institution: | (1) Department of Orthopedic Surgery and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts;(2) Dept. of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, 02115 Boston, MA |
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| Abstract: | Objectives: This project was developed to identify ways to support hospital-based improvements for the identification and management
of osteoporosis following treament of a fragility fracture.Design: This is a retrospective review of medical records of sets of consecutive patients who were admitted for surgical treatment
of fragility fracture following introduction of several versions of admission and discharge care pathways. Effectiveness of
the admission pathway was defined as % subjects with measurement of serum 25-hydroxyvitamin D (25(OH)D) during hospitalization;
effectiveness of the discharge pathway was defined as % subjects with documentation of instructions for calcium and/or vitamin
D supplementation.Setting: This study reviewed medical records of patients admitted to hospital for surgical treatment of a fragility fracture.Participants: Medical records were evaluated for 98 patients older than 50-years who were admitted with a fragility fracture of the hip
or femur.Measurements: Medical records were reviewed for the % subjects with documentation of an in-hospital order for serum 25(OH)D and with documentation
of instructions to patients upon discharge concerning calcium and vitamin D intake. Median value of serum 25(OH)D was calculated.Results: In accordance with the admission pathway, serum 25(OH)D was measured in 37% (36/98). The median 25(OH)D level was 19.5 ng/mL;
78% were vitamin D insufficient serum 25(OH)D≤ 32 ng/mL] and 58% were vitamin D deficient serum 25(OH)D ≤20 ng/mL]. In accordance
with the discharge pathway, 74% (71/96) were discharged on calcium and/or vitamin D.Conclusion: The high prevalence of vitamin D insufficiency (78%) observed in this study affirms the importance of incorporating vitamin
D supplementation in hospital-based fracture care pathways. The discharge pathway was more effective than the newer admission
pathway, a finding attributable to effects of familiarity, retraining, and introduction of computer-prompts. These evolving
pathways represent a much-needed paradigm shift in the care of fragility fracture patients. |
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| Keywords: | Fracture vitamin D osteoporosis care improvement |
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