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How can the orthopedic surgeon ensure optimal Vitamin D status in patients operated for an osteoporotic fracture?

How can the orthopedic surgeon ensure optimal Vitamin D status in patients operated for an osteoporotic fracture?
How can the orthopedic surgeon ensure optimal Vitamin D status in patients operated for an osteoporotic fracture?
With the aging of the population, osteoporosis and fragility fractures represent a dramatic challenge for health burden and medical professionals. Hip fractures in particular with a 1-year excess mortality of at least 20% account for the high burden of osteoporosis in terms of morbidity and costs [1,2,3]. Thirty percent of these patients become permanently disabled, while 40% of them loose the ability to walk independently and 80% become dependent for the activities of daily living after the fracture [4, 5]. Total fragility fractures in the largest five European Union (EU) countries and Sweden (EU6) are estimated to increase by 23% from 2.7 million in 2017 to 3.3 million on 2030 [5]. In EU6, an estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures, and a 27% increase of the resulting annual fracture-related costs of 37.5 billion euros in 2017 is expected by 2030 [5].

Among the various risk factors for fragility fractures, vitamin D deficiency appears to play a significant role [6, 7]. Vitamin D is a pleiotropic substance, with receptors and effects in a large variety of tissues [8]. Vitamin D deficiency is implicated in impaired muscle function and risk of falling [9, 10] and in calcium and phosphorus homeostasis [11]. Low calcifediol levels, hence vitamin D deficiency, are consistently found in patients with fragility fractures, including hip fractures [12, 13]. In addition, vitamin D deficiency is associated with reduced mobility after hip fracture surgical repair [14].

In the present narrative review, the role of vitamin D deficiency in the pathophysiology and the recovery of fragility fractures is addressed, and the ways to detect and correct it, as available to the orthopedic surgeon, who is at the forefront of the problem, are discussed. Depending on the local structure, other specialties such as geriatrician in the frame of orthogeriatric units and metabolic bone diseases specialists are essential complements for the orthopedic surgeon in the early management of fractured patients.
Fracture healing, Fracture liaison service, Fragility fracture, Rehabilitation, Vitamin D
0937-941X
1921-1935
Chevalley, Thierry
6ee10580-2048-4dd2-bff0-26a2b2950dc9
Brandi, Maria Luisa
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Cavalier, Etienne
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Harvey, Nicholas
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Iolascon, Giovanni
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Cooper, Cyrus
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Hannouche, Didier
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Kaux, Jean-Francois
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Kurth, Andreas
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Maggi, Stefania
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Maier, Gerrit
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Papavasiliou, Kyriakos
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Al-Daghri, Nasser M.
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Sosa-Henríquez, Manuel
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Suhm, Norbert
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Tarantino, Umberto
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Reginster, Jean-Yves
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Rizzoli, Rene
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Chevalley, Thierry
6ee10580-2048-4dd2-bff0-26a2b2950dc9
Brandi, Maria Luisa
5828a1bf-dd91-4cfb-b362-e345cc65020f
Cavalier, Etienne
bc312308-1b70-4434-ab15-28860479d2e9
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Iolascon, Giovanni
d4c5e844-8f3e-4964-8b97-6b22e3efac2a
Cooper, Cyrus
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Hannouche, Didier
2bdfac8a-622e-4f03-89af-a4250ea0e8c0
Kaux, Jean-Francois
a69c85d7-28b1-410d-90f6-e3977445f817
Kurth, Andreas
5681eee6-8950-41bd-9fda-9b503b2a4e99
Maggi, Stefania
269c4058-6259-4392-a884-4fca4ffe5c68
Maier, Gerrit
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Papavasiliou, Kyriakos
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Al-Daghri, Nasser M.
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Sosa-Henríquez, Manuel
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Suhm, Norbert
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Tarantino, Umberto
881aa033-d5f5-4a6f-a692-13077c03b435
Reginster, Jean-Yves
db56b103-184d-46e1-9600-f47f7a09a492
Rizzoli, Rene
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Chevalley, Thierry, Brandi, Maria Luisa, Cavalier, Etienne, Harvey, Nicholas, Iolascon, Giovanni, Cooper, Cyrus, Hannouche, Didier, Kaux, Jean-Francois, Kurth, Andreas, Maggi, Stefania, Maier, Gerrit, Papavasiliou, Kyriakos, Al-Daghri, Nasser M., Sosa-Henríquez, Manuel, Suhm, Norbert, Tarantino, Umberto, Reginster, Jean-Yves and Rizzoli, Rene (2021) How can the orthopedic surgeon ensure optimal Vitamin D status in patients operated for an osteoporotic fracture? Osteoporosis International, 32 (10), 1921-1935. (doi:10.1007/s00198-021-05957-9).

Record type: Article

Abstract

With the aging of the population, osteoporosis and fragility fractures represent a dramatic challenge for health burden and medical professionals. Hip fractures in particular with a 1-year excess mortality of at least 20% account for the high burden of osteoporosis in terms of morbidity and costs [1,2,3]. Thirty percent of these patients become permanently disabled, while 40% of them loose the ability to walk independently and 80% become dependent for the activities of daily living after the fracture [4, 5]. Total fragility fractures in the largest five European Union (EU) countries and Sweden (EU6) are estimated to increase by 23% from 2.7 million in 2017 to 3.3 million on 2030 [5]. In EU6, an estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures, and a 27% increase of the resulting annual fracture-related costs of 37.5 billion euros in 2017 is expected by 2030 [5].

Among the various risk factors for fragility fractures, vitamin D deficiency appears to play a significant role [6, 7]. Vitamin D is a pleiotropic substance, with receptors and effects in a large variety of tissues [8]. Vitamin D deficiency is implicated in impaired muscle function and risk of falling [9, 10] and in calcium and phosphorus homeostasis [11]. Low calcifediol levels, hence vitamin D deficiency, are consistently found in patients with fragility fractures, including hip fractures [12, 13]. In addition, vitamin D deficiency is associated with reduced mobility after hip fracture surgical repair [14].

In the present narrative review, the role of vitamin D deficiency in the pathophysiology and the recovery of fragility fractures is addressed, and the ways to detect and correct it, as available to the orthopedic surgeon, who is at the forefront of the problem, are discussed. Depending on the local structure, other specialties such as geriatrician in the frame of orthogeriatric units and metabolic bone diseases specialists are essential complements for the orthopedic surgeon in the early management of fractured patients.

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Accepted/In Press date: 9 April 2021
e-pub ahead of print date: 20 May 2021
Keywords: Fracture healing, Fracture liaison service, Fragility fracture, Rehabilitation, Vitamin D

Identifiers

Local EPrints ID: 449628
URI: http://eprints.soton.ac.uk/id/eprint/449628
ISSN: 0937-941X
PURE UUID: a4c13698-0930-44f1-8755-5db7cc55f03e
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 09 Jun 2021 16:31
Last modified: 24 Nov 2021 02:38

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Contributors

Author: Thierry Chevalley
Author: Maria Luisa Brandi
Author: Etienne Cavalier
Author: Nicholas Harvey ORCID iD
Author: Giovanni Iolascon
Author: Cyrus Cooper ORCID iD
Author: Didier Hannouche
Author: Jean-Francois Kaux
Author: Andreas Kurth
Author: Stefania Maggi
Author: Gerrit Maier
Author: Kyriakos Papavasiliou
Author: Nasser M. Al-Daghri
Author: Manuel Sosa-Henríquez
Author: Norbert Suhm
Author: Umberto Tarantino
Author: Jean-Yves Reginster
Author: Rene Rizzoli

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