Approximately 300,000 patients are hospitalized each year due to hip fractures in the United States. Hip fractures are very dangerous especially for elderly and frail patients. The risk of dying from the stress of the surgery and the injury in the first few days is high. Immobility subsequent to surgery increases that risk. Problems such as pressure sores, pneumonia, and blood clots are all increased by immobility. One out of five hip fracture patients dies within a year of their injury.
Over 90% of hip fractures are caused by falling, most often by falling sideways onto the hip. Treatment typically includes surgery and hospitalization, usually for about one week, and is frequently followed by admission to a nursing home and extensive rehabilitation. Up to one in four adults who lived independently before their hip fracture remains in a nursing home for at least a year after their injury. Medicare costs for hip fractures are around $2.9 billion per year.
Fracturing one’s hip may involve three separate problems.
- The first is that muscle strength often fails, causing the person to be too weak to keep from falling.
- Likewise, balance may be impaired leading to the fall.
- Third, the bones may be osteoporotic, or even osteomalatic (adult rickets), so a minor fall or minor trauma results in a fracture.
Vitamin D appears to help all three of these problems. I reviewed the evidence about vitamin D and muscle strength, as well as vitamin D and balance in my paper about vitamin D and athletic performance. Certainly most of the useful information about both was obtained by the Germans in the 1950s, when they studied the musculoskeletal effects of UVB radiation.
Very recently, Dr. Barker at the Orthopedic Specialty Hospital in Murray Utah found that muscle strength in younger patients is related to vitamin D levels, but the association only held true for levels below 32 ng/ml. That is, levels higher than 32 ng/ml were not associated with any more muscle strength. They also found that vitamin D deficient patients had more inflammation.
Barker T, Martins TB, Hill HR, Kjeldsberg CR, Dixon BM, Schneider ED, Henriksen VT, Weaver LK. Circulating pro-inflammatory cytokines are elevated and peak power output correlates with 25-hydroxyvitamin D in vitamin D insufficient adults. Eur J Appl Physiol. 2013 Jan 6
Also, Dr. de Koning and colleagues of the University of Calgary recently found that 25(OH)D levels lower than 28 ng/ml inversely correlated with hip fractures in 254 elderly patients.
However, beyond that they found a much more complicated relationship with 25(OH)D, with levels above 90 ng/ml and levels around 22 ng/ml having the lowest rate of hip fracture. I suspect the complicated relationship with higher levels may have been confounded by concomitant vitamin A intake. Excess vitamin A intake, common in many in North America, has been associated with fractures.
A recent study also found a similar relationship between vitamin D, vitamin A and osteoporosis. Bone density measurements revealed that the risk of osteoporosis was 8 times higher in women with the highest retinol levels compared to the lowest levels. Women with low vitamin D levels had an even greater increased risk of osteoporosis when they had high retinol levels compared to low.
Mata-Granados JM, Cuenca-Acevedo JR, Luque de Castro MD, Holick MF, Quesada-Gómez JM. Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal women. Arch Osteoporos. 2013 Dec;8(1-2):124
What is a good strategy for avoiding hip fractures? One part of the puzzle seems to be getting both adequate vitamin D and avoiding excessive vitamin A. This is something I have always stood for and still do.