Topical Area: Aging and Chronic Disease
Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. This study aims to determine whether 25-hydroxyvitamin D (25(OH)D) or the Geriatric Nutritional Risk Index (GNRI) is associated with short term mortality or ability to walk after hip fracture surgery.
Methods : Patients undergoing hip fracture repair were included in this study. Mortality and walking ability were assessed at 30 and 60 days after hip fracture surgery. Pre-operative serum albumin and 25(OH)D were measured. Patients were characterized with 25(OH)D < 12ng/mL, 12 to < 20, 20 to < 30 or ≥ 30. GNRI was calculated from albumin and body weight and patients were categorized into major/moderate nutritional risk (< 92), low risk (92 to < 98) or in good nutritional status (≥ 98).
Results : Of the 290 patients (82 ± 7 years, BMI 25 ± 5 kg/m2), 73% were females. Compared to patients with vitamin D deficiency (< 12 ng/mL), those with vitamin D levels in higher categories had increased ability to walk at 30 days (p = 0.031): 12 to < 20 ng/ml (adjusted odds ratio=2.61; 95% confidence interval= 1.13-5.99); 20 to < 30 ng/ml (3.48; 1.53-7.95); ≥ 30 ng/ml (2.84; 1.12-7.20). In addition, patients also had increased mobility at 60 days in these same higher vitamin D categories 12 to < 20 (2.67; 1.14-6.25); 20 to < 30 (3.42; 1.46-8.00); ≥ 30 ng/ml (3.67; 1.37-9.82) compared to the reference group (< 12 ng/mL; p = 0.028). There was no association of vitamin D with mortality at either time point. GNRI was not associated with mortality or walking ability.
In patients with hip fracture, vitamin D deficiency (< 12 ng/mL) was associated with reduced ambulation after surgery, whereas GNRI was not associated with any outcomes. Mechanisms that attenuate mobility due to vitamin D deficiency should be examined in future studies.
Funding Sources : ONE Nutrition Grant to SAS and JLC