- Email: [email protected]
Prevalence and clinical correlation of vitamin D inadequacy in traumatic elderly patients underwent orthopaedic surgery
Abstracts / Osteoporosis and Sarcopenia 3 (2017) S36eS52
time of delivery. Subjects randomized into four groups in ratio of 1:1:1:1(Group 1 - active control group received 600 units of vitamin D per day; Group 2 e 1000 units/day; Group 3 e 2000 units/day; Group 4 - 4000 units per day). All groups received 1000 mg of elemental calcium (in two divided doses), and similar nutritional and lifestyle advice for standard management of pregnancy. Doses of vitamin D were calculated on daily basis but given orally, once a month, supervised in hospital. The primary outcome of the study was changes in vitamin D status of mother and newborn. Secondary outcomes of the study were weight gain during pregnancy, blood pressure, preterm labor, pre-eclampsia, fetal growth, newborn’s anthropometry, and insulin resistance in mother as well as in cord blood. Safety of intervention was assessed by regular monitoring of urinary calcium creatinine ration and serum calcium levels Results: Total 243 subjects completed the study and were analyzed. High prevalence of vitamin D deficiency was seen in study population. Of total 243 subjects, 93.6% of subjects had VDD (S.VitD <20 ng/ml) while 97.5% subjects had S.VitD level <30 ng/ml. No significant difference was seen in S.VitD level among all four groups. Improvement in S.VitD level after supplementation is shown in Table -1. Among cord S.VitD status, 77.8% babies in group 1, 47.1% in group 2, 17.8% in group 3 and 6.2% in group 4 were VDD. Apart from S.VitD level, no significant difference was observed among all four groups in any other maternal, fetal and newborn parameters (maternal wt gain, pre-eclampsia, fetal growth, newborn’s anthropometry, and insulin resistance in mother as well as in cord blood). Conclusion: Our study shows that supplementation of vitamin D in mother improves vitamin D status of newborn. However, vitamin D supplementation during pregnancy did not shown any effect on any other maternal, fetal and newborn parameter.
Parameter
Group 1
Group 2
Group 3
Group 4
Dose of Vit D Baseline S. Vit D S. vit D 24-28 wks S. vit D at delivery Cord blood S.vit D
600 IU/Day 9.09±5.69 11.87±7.79 11.4±9.95 12.49±12.95
1000 IU/Day 7.51± 3.91 19.03±6.87 20.34±8.66 22114±9.17
2000 IU/Day 10.63±7.67 22.38±7.52 27.45±10.64 30.67±14.15
4000 IU/Day 8.89±7.4 30.68±10.67 37.17±12.4 41.38±14.71
All values are in ng/ml.
71 PREVALENCE AND CLINICAL CORRELATION OF VITAMIN D INADEQUACY IN TRAUMATIC ELDERLY PATIENTS UNDERWENT ORTHOPAEDIC SURGERY Ong-Art Phruetthiphat, Teerapat Tutaworn, Thawee Songpatanasilp. Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand Introduction: High prevalence of vitamin D deficiency has been identified in more than 1 billion people around the world, especially in Middle-East and Asia. However, no study focuses on fracture and vitamin D in elderly Thai populations. So our purpose of study would like to designate the prevalence and clinical correlation of Vitamin D inadequacy in traumatic elderly patients underwent Orthopaedic Surgery. Materials and methods: After institutional review board approval, a prospective study of 200 elderly patients with low energy trauma were identified and they further underwent surgical intervention for fractures between the period of January 2015 and December 2015.Patients were stratified into 2 cohorts: normal vitamin D (more than 30 ng/ml) and vitamin D inadequacy (less than 30 ng/ml) and we have compared the outcome in both groups by ambulatory status at 1 year, time to union and implant failure. Results: Prevalence of Vitamin D inadequacy (<30 ng/ml) was 70.5 percent. Hip fracture had the highest prevalence of vitamin D inadequacy while upper extremities fracture had the lowest prevalence of vitamin D inadequacy (71.9%versus 61.5%).The average median time of sun exposure was significantly different between 30 minutes a day for sufficient Vitamin D level and 15 minutes a day in Vitamin D inadequacy group (pvalue<0.001). Ambulatory status, clinical union, radiographic union, and
S39
implant failure at 1 year follow up were not significantly difference between groups (p-value¼0.958, 0.741, 0.566, and 1.000 respectively). Discussion: Hip fractures had not only the highest prevalence of vitamin D inadequacy, but also the highest Charlson Comorbity Index because they were occurred among the oldest population that probably correlates with higher comorbidities, lower activity level, lower sun exposure, and gastrointestinal malabsorption. However, there was no significant difference in ambulatory status at 1 year, time to union, and implant failure between vitamin D inadequacy and normal vitamin D groups because the successful outcome of hip fractures comes mainly from properly surgical factors (surgical technique and implant) than only vitamin D level. Conclusion: Even though there was no difference in time to union and one-year ambulatory status between vitamin D inadequacy and normal vitamin D level, vitamin D inadequacy is likely common in traumatic elderly patients. Therefore, we should raise attentiveness among physician to determine Vitamin D status in elderly patients. Public health strategy should focus on patient education including adequate calcium and vitamin D diet, supplements, and sufficient sun-exposure for elderly population. 72 CHARACTERISTICS OF FALLS AND FALL-RELATED FRACTURES IN HOSPITALIZED PATIENTS Young Jun Won 1, Yoo Mee Kim 1, Se Wha Kim 1, Bo Ram Kim 2, Jung Gu Kim 3, Sung-Woo Kim 4. 1 Department of Internal Medicine, Catholic Kwandong University, College of Medicine, Incheon, 22711, South Korea; 2 Performance Improvement department, International St. Mary’s Hospital, Incheon, 22711, South Korea; 3 Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, 03080, South Korea; 4 Department of Biomedical Engineering, Catholic Kwandong University, College of Creative Convergence Engineering, Incheon, 22711, South Korea Introduction: Falls and fall-related injuries in hospitals present serious problems for patients, their families and hospital personnel. The patient can experience from simple contusion to severe damage such as fracture due to falls. The purpose of this study was to evaluate the characteristics and fallrelated risk factors of major injury such as fracture in hospitalized patients. Materials & methods: This study retrospectively analyzed 350 cases of falls, 26 cases of fall-related major injuries, and 11 cases of fall-related fractures from March 2014 to May 2017. The data were collected from the patient’s electronic medical records of acute care setting university hospital. Data were analyzed with Mann-Whitney test and Pearson chi square test. Results: Of the patients who had fallen, 76.3% were alert and 12.9% were drowsy. 62.6% of the falls occurred in the ward, 10.6% in the corridor, and 7.7% in the rest room and shower booth. The percentage of falls was 63.4% higher in patients with caregivers than those without caregivers. 66 % of the fall patients were in need of caregivers and 32% were considered functionally independent. The major admitted causes of fall patients were cancers (65 cases), diabetes (41 cases), cerebrovascular disease (33 cases), and hypertension and cardiovacular disease (24 cases). The drugs administered to fall patients were antihypertensive drugs (91 cases), anxiolytic agents (80 cases), sleeping pills (70 cases), narcotic analgesics (51 cases), anticonvulsants (45 cases), antidiabetic agents (38 cases), and antidepressant agents (34 cases). The mean age of major injury patients was 69 years (range: 25-93 years). The mean age of fall-related osteoporotic fracture patients was 71.7 years (range: 48-91 years). 63.6% of fall-related osteoporotic fracture patients were women, and 54.5% were ward-related fracture. 7 cases of fall-related osteoporotic fracture occurred in medical unit and 4 cases occurred in surgery unit. The significant risk factors of fall-related major injury were age (p<0.05), chronic renal failure (CRF) (p<0.005), and osteoporosis (p<0.05). Discussions: Various factors contributed to falls and fall-related injuries in hospitalized patients, and severe injuries such as fracture and hematoma developed. Medical professionals need to analyze risk factors of fall and fall-related injury in hospitalized patients and provide appropriate interventions in high risk patients. Because each hospital has a different patient status, it is necessary to analyze the risk factors of falls for each
time of delivery. Subjects randomized into four groups in ratio of 1:1:1:1(Group 1 - active control group received 600 units of vitamin D per day; Group 2 e 1000 units/day; Group 3 e 2000 units/day; Group 4 - 4000 units per day). All groups received 1000 mg of elemental calcium (in two divided doses), and similar nutritional and lifestyle advice for standard management of pregnancy. Doses of vitamin D were calculated on daily basis but given orally, once a month, supervised in hospital. The primary outcome of the study was changes in vitamin D status of mother and newborn. Secondary outcomes of the study were weight gain during pregnancy, blood pressure, preterm labor, pre-eclampsia, fetal growth, newborn’s anthropometry, and insulin resistance in mother as well as in cord blood. Safety of intervention was assessed by regular monitoring of urinary calcium creatinine ration and serum calcium levels Results: Total 243 subjects completed the study and were analyzed. High prevalence of vitamin D deficiency was seen in study population. Of total 243 subjects, 93.6% of subjects had VDD (S.VitD <20 ng/ml) while 97.5% subjects had S.VitD level <30 ng/ml. No significant difference was seen in S.VitD level among all four groups. Improvement in S.VitD level after supplementation is shown in Table -1. Among cord S.VitD status, 77.8% babies in group 1, 47.1% in group 2, 17.8% in group 3 and 6.2% in group 4 were VDD. Apart from S.VitD level, no significant difference was observed among all four groups in any other maternal, fetal and newborn parameters (maternal wt gain, pre-eclampsia, fetal growth, newborn’s anthropometry, and insulin resistance in mother as well as in cord blood). Conclusion: Our study shows that supplementation of vitamin D in mother improves vitamin D status of newborn. However, vitamin D supplementation during pregnancy did not shown any effect on any other maternal, fetal and newborn parameter.
Parameter
Group 1
Group 2
Group 3
Group 4
Dose of Vit D Baseline S. Vit D S. vit D 24-28 wks S. vit D at delivery Cord blood S.vit D
600 IU/Day 9.09±5.69 11.87±7.79 11.4±9.95 12.49±12.95
1000 IU/Day 7.51± 3.91 19.03±6.87 20.34±8.66 22114±9.17
2000 IU/Day 10.63±7.67 22.38±7.52 27.45±10.64 30.67±14.15
4000 IU/Day 8.89±7.4 30.68±10.67 37.17±12.4 41.38±14.71
All values are in ng/ml.
71 PREVALENCE AND CLINICAL CORRELATION OF VITAMIN D INADEQUACY IN TRAUMATIC ELDERLY PATIENTS UNDERWENT ORTHOPAEDIC SURGERY Ong-Art Phruetthiphat, Teerapat Tutaworn, Thawee Songpatanasilp. Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand Introduction: High prevalence of vitamin D deficiency has been identified in more than 1 billion people around the world, especially in Middle-East and Asia. However, no study focuses on fracture and vitamin D in elderly Thai populations. So our purpose of study would like to designate the prevalence and clinical correlation of Vitamin D inadequacy in traumatic elderly patients underwent Orthopaedic Surgery. Materials and methods: After institutional review board approval, a prospective study of 200 elderly patients with low energy trauma were identified and they further underwent surgical intervention for fractures between the period of January 2015 and December 2015.Patients were stratified into 2 cohorts: normal vitamin D (more than 30 ng/ml) and vitamin D inadequacy (less than 30 ng/ml) and we have compared the outcome in both groups by ambulatory status at 1 year, time to union and implant failure. Results: Prevalence of Vitamin D inadequacy (<30 ng/ml) was 70.5 percent. Hip fracture had the highest prevalence of vitamin D inadequacy while upper extremities fracture had the lowest prevalence of vitamin D inadequacy (71.9%versus 61.5%).The average median time of sun exposure was significantly different between 30 minutes a day for sufficient Vitamin D level and 15 minutes a day in Vitamin D inadequacy group (pvalue<0.001). Ambulatory status, clinical union, radiographic union, and
S39
implant failure at 1 year follow up were not significantly difference between groups (p-value¼0.958, 0.741, 0.566, and 1.000 respectively). Discussion: Hip fractures had not only the highest prevalence of vitamin D inadequacy, but also the highest Charlson Comorbity Index because they were occurred among the oldest population that probably correlates with higher comorbidities, lower activity level, lower sun exposure, and gastrointestinal malabsorption. However, there was no significant difference in ambulatory status at 1 year, time to union, and implant failure between vitamin D inadequacy and normal vitamin D groups because the successful outcome of hip fractures comes mainly from properly surgical factors (surgical technique and implant) than only vitamin D level. Conclusion: Even though there was no difference in time to union and one-year ambulatory status between vitamin D inadequacy and normal vitamin D level, vitamin D inadequacy is likely common in traumatic elderly patients. Therefore, we should raise attentiveness among physician to determine Vitamin D status in elderly patients. Public health strategy should focus on patient education including adequate calcium and vitamin D diet, supplements, and sufficient sun-exposure for elderly population. 72 CHARACTERISTICS OF FALLS AND FALL-RELATED FRACTURES IN HOSPITALIZED PATIENTS Young Jun Won 1, Yoo Mee Kim 1, Se Wha Kim 1, Bo Ram Kim 2, Jung Gu Kim 3, Sung-Woo Kim 4. 1 Department of Internal Medicine, Catholic Kwandong University, College of Medicine, Incheon, 22711, South Korea; 2 Performance Improvement department, International St. Mary’s Hospital, Incheon, 22711, South Korea; 3 Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, 03080, South Korea; 4 Department of Biomedical Engineering, Catholic Kwandong University, College of Creative Convergence Engineering, Incheon, 22711, South Korea Introduction: Falls and fall-related injuries in hospitals present serious problems for patients, their families and hospital personnel. The patient can experience from simple contusion to severe damage such as fracture due to falls. The purpose of this study was to evaluate the characteristics and fallrelated risk factors of major injury such as fracture in hospitalized patients. Materials & methods: This study retrospectively analyzed 350 cases of falls, 26 cases of fall-related major injuries, and 11 cases of fall-related fractures from March 2014 to May 2017. The data were collected from the patient’s electronic medical records of acute care setting university hospital. Data were analyzed with Mann-Whitney test and Pearson chi square test. Results: Of the patients who had fallen, 76.3% were alert and 12.9% were drowsy. 62.6% of the falls occurred in the ward, 10.6% in the corridor, and 7.7% in the rest room and shower booth. The percentage of falls was 63.4% higher in patients with caregivers than those without caregivers. 66 % of the fall patients were in need of caregivers and 32% were considered functionally independent. The major admitted causes of fall patients were cancers (65 cases), diabetes (41 cases), cerebrovascular disease (33 cases), and hypertension and cardiovacular disease (24 cases). The drugs administered to fall patients were antihypertensive drugs (91 cases), anxiolytic agents (80 cases), sleeping pills (70 cases), narcotic analgesics (51 cases), anticonvulsants (45 cases), antidiabetic agents (38 cases), and antidepressant agents (34 cases). The mean age of major injury patients was 69 years (range: 25-93 years). The mean age of fall-related osteoporotic fracture patients was 71.7 years (range: 48-91 years). 63.6% of fall-related osteoporotic fracture patients were women, and 54.5% were ward-related fracture. 7 cases of fall-related osteoporotic fracture occurred in medical unit and 4 cases occurred in surgery unit. The significant risk factors of fall-related major injury were age (p<0.05), chronic renal failure (CRF) (p<0.005), and osteoporosis (p<0.05). Discussions: Various factors contributed to falls and fall-related injuries in hospitalized patients, and severe injuries such as fracture and hematoma developed. Medical professionals need to analyze risk factors of fall and fall-related injury in hospitalized patients and provide appropriate interventions in high risk patients. Because each hospital has a different patient status, it is necessary to analyze the risk factors of falls for each