Last summer, I found myself sidelined by pain in my right hip that made even the most basic daily tasks excruciating.

I could still get around, albeit gingerly, so I talked myself into believing that the injury was nothing more than a strain.

Chalking it up to overuse or improper training, I took what I believed to be the proper steps – resting and applying ice, finding a physical therapist, and doing the prescribed home exercises.

The eventual diagnosis of a femoral neck fracture came as a surprise. I am not elderly, nor did I have any of the common risk factors, such as being inactive or experiencing a fall or other trauma.

Not to mention, my diet contains plenty of calcium-containing dairy products and calcium-fortified foods, reducing my risk of bone thinning.

As part of the post-op recovery instructions, my orthopedic surgeon recommended that I supplement with vitamin D, as he considered me at high risk for vitamin D deficiency.

Living in the Midwest, vitamin D deficiency is common, with between 50 to 75 percent of the adult population being vitamin D deficient. Winter in Chicago is notoriously punishing, as the lack of sunlight significantly increases this risk.

Because most people get enough vitamin D in their foods or from exposure to sunlight, the U.S. Preventive Services Task Force does not recommend supplemental vitamin D in its active form of Vitamin D3.

There are, however, two exceptions: babies who are exclusively breast-fed should receive 400 IU a day of supplemental vitamin D, because it isn’t contained in human milk and because they don’t get out into the sun much; and adults over the age of 65 should receive 800 IU daily because it’s been shown to reduce the high risk of bone fractures.

At least 600 mg of calcium per day are recommended. Patients are advised to speak with their physician or internist about adjusting these dosages as appropriate. Lab tests and bone mineral density will establish whether higher or lower levels of vitamin D3 and calcium are needed.

Why Is Vitamin D Important?

The body needs vitamin D to absorb calcium. Without enough vitamin D, one cannot form enough of the hormone Calcitrol (known as the active vitamin D, or vitamin D3). This, in turn, leads to insufficient calcium absorption from the diet.

In this situation, the body must take calcium from its stores in the skeleton, which weakens existing bone and prevents the formation of new, strong bone. Low vitamin D levels lead to low calcium absorption, which can lead to fractures and weakened bone (osteopenia and osteoporosis).

Even with the link between vitamin D intake and bone strength well-established, there is evidence that vitamin D levels may not be treated among older hip fracture patients.

According to published research in the Osteoporosis International journal, only about 20 percent of elderly adults receive vitamin D at the time of their fracture and after the event. This is despite the documented 81 percent prevalence of vitamin D deficiency.

Additionally, research has shown that supplemental vitamin D reduces the risk of both falls and hip fractures in older adults. There is an imperative to further study the use of vitamin D for prevention as well as post-fracture health. This calls for the engagement of multiple disciplines – primary care physicians, surgeons, pharmacists, and physical therapists – to help ensure successful outcomes.

Sources:

Maier, et al. “Before and after hip fracture, vitamin D deficiency may not be treated sufficiently.” Osteoporosis Int. November 2013. Retrieved October 7, 2014 from: http://www.ncbi.nlm.nih.gov/pubmed/23716038
“The Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You.” NIH Publication No. 12–7827. March 2012.

http://www.niams.nih.gov/Health_Info/Bone/SGR/surgeon_generals_report.asp

Last Updated: October 2014

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