RT Journal
A1 LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J
T1 OCcult vitamin d deficiency in postmenopausal us women with acute hip fracture
JF JAMA
JO JAMA
YR 1999
FD April 28
VO 281
IS 16
SP 1505
OP 1511
DO 10.1001/jama.281.16.1505
UL http://dx.doi.org/10.1001/jama.281.16.1505
AB Context 
                  Low vitamin D levels may contribute to hip fractures
in women, although limited data are available on vitamin D levels in US
women admitted with acute hip fractures.Objective 
                  To determine whether postmenopausal women with hip
fractures have low vitamin D and high parathyroid hormone levels
compared with nonosteoporotic and osteoporotic women admitted for
elective joint replacement.Design 
                  Comparative case series conducted between January 1995 and
June 1998.Setting and Patients 
                  Ninety-eight postmenopausal
community-dwelling women with no secondary causes of bone loss admitted
for hip replacement, of whom 30 women had acute hip fractures and 68
women were admitted for elective joint replacement. Of the women
admitted for elective joint replacement, 17 had osteoporosis and 51 did
not. Women with comorbid conditions or who were taking medications that
affect bone density and turnover were excluded.Main Outcome Measures 
                  Primary measures were levels of vitamin D
and parathyroid hormone; secondary measures were body composition and
markers of bone turnover.Results 
                  Women with hip fractures had lower levels of
25-hydroxyvitamin D than women without osteoporosis admitted for
elective joint replacement (P=.02) and than
women with osteoporosis admitted for elective joint replacement
(P=.01) (medians, 32.4, 49.9, and 55.0 nmol/L,
respectively; comparisons adjusted for age and estrogen intake).
Parathyroid hormone levels were higher in women with fractures than
women in the nonosteoporotic control group (P<.001) or than
elective osteoporotic women (P=.001) (medians,
5.58, 3.26, and 3.79 pmol/L, respectively; comparisons adjusted for age
and estrogen intake). Fifteen patients (50.0%) with hip fractures had
deficient vitamin D levels (≤30.0 nmol/L) and 11 (36.7%) had a
parathyroid hormone level greater than 6.84 pmol/L. Levels of
N-telopeptide, a marker of bone resorption, were greater in
the women with hip fractures than in the elective nonosteoporotic
controls (P=.004).Conclusions 
                  Postmenopausal community-living women who presented
with hip fracture showed occult vitamin D deficiency. Repletion of
vitamin D and suppression of parathyroid hormone at the time of
fracture may reduce future fracture risk and facilitate hip fracture
repair. Because vitamin D deficiency is preventable, heightened
awareness is necessary to ensure adequate vitamin D nutrition,
particularly in northern latitudes.