A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

Xiaoxu Sun; Benjamin Z Leder; Marcy B Bolster; Thuan V Ly; Esteban Franco-Garcia; Charles T Pu; WuQiang Fan

doi:10.1210/jendso/bvae050

A Fracture Liaison Service to Address Vitamin D Deficiency for Patients Hospitalized for Osteoporotic Fracture

J Endocr Soc. 2024 Mar 12;8(5):bvae050. doi: 10.1210/jendso/bvae050.

Authors

Xiaoxu Sun^{1

2}, Benjamin Z Leder², Marcy B Bolster³, Thuan V Ly⁴, Esteban Franco-Garcia⁵, Charles T Pu⁵, WuQiang Fan²

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
² Division of Endocrine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
³ Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
⁴ Harvard Orthopaedic Trauma Initiative, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
⁵ Division of Geriatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Abstract

Context: Addressing vitamin D deficiency (VDD) is important for fracture secondary prevention.

Objectives: To explore the function of a fracture liaison service (FLS) to address VDD.

Design setting and patients: An observational study of patients admitted to the Massachusetts General Hospital with fractures between January 1, 2016, and October 31, 2023, cared for by the FLS.

Intervention: Ergocalciferol 50 000 international units (50ku-D2) oral daily for 3 to 7 days.

Main outcomes measures: VDD prevalence. Efficacy of inpatient daily 50ku-D2 in raising serum 25-hydroxyvitamin D (25OHD) levels.

Results: Of the 2951 consecutive patients, 724 (24.53%) had VDD (defined by 25OHD ≤ 19 ng/mL). Men (252/897, or 28.09%) were more likely than women (472/2054, or 22.98%) to have VDD (P = .003). VDD was seen in 41.79% (117/280), 24.41% (332/1360), and 20.98% (275/1311) of patients of aged ≤59, 60 to 79, and ≥80 years, respectively (P < .00001). Of the 1303 patients with hip fractures, 327 (25.09%) had VDD, which was associated with a longer length of stay (8.37 ± 7.35 vs 7.23 ± 4.78 days, P = .009) and higher trend of 30-day-readmission rate (13.63% vs 18.35%, P = .037). In a cohort of 32 patients with complete data, each dose of 50ku-D2 increased serum 25OHD by 3.62 ± 2.35 ng/mL without affecting serum calcium or creatinine levels.

Conclusion: VDD was seen in nearly 25% of Massachusetts General Hospital FLS patients and more prevalent in male and younger patients. VDD was associated with longer length of stay and higher 30-day-readmission risk in patients with hip fracture. Daily 50ku-D2 appeared to be a practical way to quickly replete vitamin D in the inpatient setting.

Keywords: fracture liaison service; inpatient; osteoporotic fractures; treatment gap; vitamin D deficiency.