Vitamin D and Calcium levels in Elderly Patients presenting with Hip Fragility Fractures in KNH

Abstract

BACKGROUND Fragility fractures are associated with significantly reduced bone strength in elderly patients due to changes in bone mass, architecture and material characteristics. They are occasioned by low energy injuries in the elderly. Vitamin D deficiency has been identified as an independent risk factor for hip fragility fractures. It is associated with muscle weakness and poor muscle function among the elderly, with increased risk of falls, poor rehabilitation post injury and increased risk of re-fracture in these patients. Studies documenting vitamin D levels in Africa are few, and mainly from South Africa and West Africa. No study has been done in Africa specifically studying vitamin D in patients with hip fragility fractures. OBJECTIVE: To determine the pattern of serum calcium and vitamin D among elderly patients presenting with hip fragility fractures at KNH. METHODOLOGY: This was a hospital based descriptive cross-sectional Study carried out among elderly patients (>65yrs) presenting with hip fragility fractures at the Kenyatta National Hospital Accident and emergency and Orthopedic wards. The study duration was June – September 2019. Consecutive sampling was done until the desired sample of 65 was achieved. The patient’s biodata, mechanism of injury, date and type of injury was documented. Upon admission, the serum calcium and hydroxyvitamin D levels were assayed and recorded. DATA MANAGEMENT: Data was entered, coded and analyzed using Statistical Package for Social Sciences (SPSS)version 23. The primary outcomes were the serum level of 25 hydroxycholecalciferol and calcium. Means and standard deviations as well as Median and IQR were reported for serum level of 25 hydroxycholecalciferol and calcium. Pearsons Chi Square test were done to test for association between serum vitamin D with selected patient characteristics. RESULTS: The study recruited 65 participants. Majority were female (58.5%), and the participants mean age was 74.5 (SD = 8.9) years. The proportion of vitamin D deficiency was 48%, insufficiency 38% and normal Vitamin D was 14%. The mean serum Vitamin D was 21.5 (SD =7.7) ng/ml. The albumin adjusted serum calcium level was normal in 89.2% and low in only 10.8% of the participants. A Fisher’s exact test was used to test the association between Calcium level and gender, and there was no statistical association between Calcium level and gender. The most common type of hip fragility fractures was neck of femur (58.5%), followed by intertrochanteric (27.7%) then sub-trochanteric (13.8%). There was a statistically significant, though weak, negative correlation between age and serum vitamin D levels. CONCLUSION: This study demonstrated a high prevalence of vitamin D deficiency and insufficiency among the elderly patients presenting with hip fragility fractures in KNH. Majority of the participants however had normal serum calcium levels.