Low patient compliance--a major negative factor in achieving vitamin D adequacy in elderly hip fracture patients supplemented with 800IU of vitamin D3 daily

Abstract

Achievement of adequate vitamin D3 level is crucial for the treatment of hip fracture patients. Currently used vitamin D3 supplementation in Israel ranges between 200 and 800IU/day. The study objectives were to evaluate the effects of 800IU/day vitamin D3 and 1.200mg of calcium carbonate supplementation to achieve adequate vitamin D3 level of 30ng/ml in elderly hip fracture patients. One hundred and twenty-two elderly patients after surgical hip fracture correction aged 73.0+/-9.5, who were enrolled in a post-surgical treatment program (PSTP). The patients received 800IU of vitamin D3 and 1.200mg of calcium carbonate daily. Serum 25(OH)D and plasma PTH levels were assessed during initial hospital stay and at quarterly follow-up visits for 2 years. At baseline, 120 patients (98.4%) had 25(OH)D serum level <30ng/ml. Forty-two patients (34.4%) had 25(OH)D serum level <10ng/ml and these were considered as vitamin D(3) deficient. After 3 months, 29 patients (23.8%) were fully adherent to the supplement, 32 were (26.2%) partially adherent. The dropout rate at 1 year was 55.7%. The major reason for the discontinuation of participation was non-compliance. We conclude that the majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. Compliance with calcium and vitamin D3 supplements was extremely low. An adequate vitamin D status was not achieved with daily vitamin D3 supplementation of 800IU. Supplementation strategies using a periodic single high dose of vitamin D3 might be more appropriate and should be considered in these patients.