Vitamin D, Extended Physiotherapy Prevent Second Hip Fracture

DENVER — Extended physiotherapy significantly reduced the rate of falls among patients with a prior hip fracture, and high-dose vitamin D significantly reduced the rate of hospital readmissions in a study of 173 patients.

A program of extended physiotherapy reduced the fall rate by 25%, compared with standard postfracture physiotherapy; high-dose vitamin D therapy reduced the hospital readmission rate by 39%, compared with a lower dose, the researchers found.

“The extended physiotherapy program, together with 2,000 IU vitamin D, has complementary benefits on post–hip fracture care,” Dr. Heike Bischoff-Ferrari said at the annual meeting of the American Society for Bone and Mineral Research.

The researchers enrolled 173 patients after their first acute hip fracture. Of these, most (79%) were women. Their mean age was 84 years, and 77% were living in the community. Half (51%) of the patients had severe vitamin D deficiency with serum 25-hydroxyvitamin D levels below 30 nmol/L; almost all (98%) had serum 25-hydroxyvitamin D levels below 75 nmol/L.

Patients were randomized to receive extended physiotherapy or standard physiotherapy. Extended physiotherapy consisted of supervised therapy for 1 hour per day during acute care, plus an unsupervised home program of exercises to perform regularly for 1 year. The standard therapy consisted of supervised therapy for 30 minutes per day during acute care. Physiotherapy included activities such as getting up from a chair, one-leg stands, climbing up and down stairs, and a rubber band exercise program for upper arm strength.

Patients were also randomized to receive vitamin D supplementation at 2,000 IU or 800 IU vitamin D3 per day. All patients received calcium.

Clinical assessment, which included laboratory tests and functional evaluations, took place at baseline and at 6 and 12 months' follow-up. Falls and readmissions were assessed by monthly calls to patients, patient calls to a hotline, and patient diaries.

The primary end point was the rate of falls over 12 months. The secondary end point was the rate of hospital readmission over 12 months.

In all, 86 participants were included in the high-dose vitamin D group and 87 were included in the lower-dose vitamin D group; 87 participants were included in the extensive physiotherapy group, and 86 were included in the regular physiotherapy group. The groups did not differ by age, gender, BMI, cognitive function, baseline 25-hydroxyvitamin D levels, and Charleston Comorbidity Index scores.

The researchers documented 212 falls in 92 participants. Of these, 41% fell once, 26% fell twice, 19% fell three times, and 14% fell more than three times. The rate of falls per patient-year was 1.43. There were 22 new nonvertebral fractures, nine of which were in the contralateral hip.

There were 74 readmissions among 54 participants. Of these, 72% had one readmission, 20% had two, and 8% had three. The rate of readmission was 50%.

Extended physiotherapy reduced the rate of falls by 25%, compared with regular physiotherapy, a significant reduction. Similar improvements were seen in function. However, extended physiotherapy did not reduce the rate of hospital readmissions.

There was no difference in the fall rate for the two vitamin D groups, but high-dose vitamin D did reduce the rate of hospital readmission by 39%, which was significant. There was also a significant 60% reduction in fall-related injuries. “This was mainly driven by a nonsignificant reduction in repeat nonvertebral fractures by 52%,” said Dr. Bischoff-Ferrari of the Centre on Aging and Mobility at the University Hospital Zurich.

The rate of readmissions due to infections decreased a significant 90%. Fall-related injuries went down 47% (which was nonsignificant) among those in the extended physiotherapy group, a decrease primarily driven by a nonsignificant 56% reduction in repeat nonvertebral fractures, said Dr. Bischoff-Ferrari, who is also a visiting scientist in the Bone Metabolism Laboratory at Tufts University, Boston.

In the first year after a hip fracture, an estimated 5%-10% of patients fracture the other hip and 30% are readmitted to acute care. Half of these patients are left with permanent functional impairment, a quarter require long-term care, and 10%-25% die, she said.

Dr. Bischoff-Ferrari reported having no conflicts of interest.

DENVER — Extended physiotherapy significantly reduced the rate of falls among patients with a prior hip fracture, and high-dose vitamin D significantly reduced the rate of hospital readmissions in a study of 173 patients.

A program of extended physiotherapy reduced the fall rate by 25%, compared with standard postfracture physiotherapy; high-dose vitamin D therapy reduced the hospital readmission rate by 39%, compared with a lower dose, the researchers found.

“The extended physiotherapy program, together with 2,000 IU vitamin D, has complementary benefits on post–hip fracture care,” Dr. Heike Bischoff-Ferrari said at the annual meeting of the American Society for Bone and Mineral Research.

The researchers enrolled 173 patients after their first acute hip fracture. Of these, most (79%) were women. Their mean age was 84 years, and 77% were living in the community. Half (51%) of the patients had severe vitamin D deficiency with serum 25-hydroxyvitamin D levels below 30 nmol/L; almost all (98%) had serum 25-hydroxyvitamin D levels below 75 nmol/L.

Patients were randomized to receive extended physiotherapy or standard physiotherapy. Extended physiotherapy consisted of supervised therapy for 1 hour per day during acute care, plus an unsupervised home program of exercises to perform regularly for 1 year. The standard therapy consisted of supervised therapy for 30 minutes per day during acute care. Physiotherapy included activities such as getting up from a chair, one-leg stands, climbing up and down stairs, and a rubber band exercise program for upper arm strength.

Patients were also randomized to receive vitamin D supplementation at 2,000 IU or 800 IU vitamin D3 per day. All patients received calcium.

Clinical assessment, which included laboratory tests and functional evaluations, took place at baseline and at 6 and 12 months' follow-up. Falls and readmissions were assessed by monthly calls to patients, patient calls to a hotline, and patient diaries.

The primary end point was the rate of falls over 12 months. The secondary end point was the rate of hospital readmission over 12 months.

In all, 86 participants were included in the high-dose vitamin D group and 87 were included in the lower-dose vitamin D group; 87 participants were included in the extensive physiotherapy group, and 86 were included in the regular physiotherapy group. The groups did not differ by age, gender, BMI, cognitive function, baseline 25-hydroxyvitamin D levels, and Charleston Comorbidity Index scores.

The researchers documented 212 falls in 92 participants. Of these, 41% fell once, 26% fell twice, 19% fell three times, and 14% fell more than three times. The rate of falls per patient-year was 1.43. There were 22 new nonvertebral fractures, nine of which were in the contralateral hip.

There were 74 readmissions among 54 participants. Of these, 72% had one readmission, 20% had two, and 8% had three. The rate of readmission was 50%.

Extended physiotherapy reduced the rate of falls by 25%, compared with regular physiotherapy, a significant reduction. Similar improvements were seen in function. However, extended physiotherapy did not reduce the rate of hospital readmissions.

There was no difference in the fall rate for the two vitamin D groups, but high-dose vitamin D did reduce the rate of hospital readmission by 39%, which was significant. There was also a significant 60% reduction in fall-related injuries. “This was mainly driven by a nonsignificant reduction in repeat nonvertebral fractures by 52%,” said Dr. Bischoff-Ferrari of the Centre on Aging and Mobility at the University Hospital Zurich.

The rate of readmissions due to infections decreased a significant 90%. Fall-related injuries went down 47% (which was nonsignificant) among those in the extended physiotherapy group, a decrease primarily driven by a nonsignificant 56% reduction in repeat nonvertebral fractures, said Dr. Bischoff-Ferrari, who is also a visiting scientist in the Bone Metabolism Laboratory at Tufts University, Boston.

In the first year after a hip fracture, an estimated 5%-10% of patients fracture the other hip and 30% are readmitted to acute care. Half of these patients are left with permanent functional impairment, a quarter require long-term care, and 10%-25% die, she said.

Dr. Bischoff-Ferrari reported having no conflicts of interest.

DENVER — Extended physiotherapy significantly reduced the rate of falls among patients with a prior hip fracture, and high-dose vitamin D significantly reduced the rate of hospital readmissions in a study of 173 patients.

A program of extended physiotherapy reduced the fall rate by 25%, compared with standard postfracture physiotherapy; high-dose vitamin D therapy reduced the hospital readmission rate by 39%, compared with a lower dose, the researchers found.

“The extended physiotherapy program, together with 2,000 IU vitamin D, has complementary benefits on post–hip fracture care,” Dr. Heike Bischoff-Ferrari said at the annual meeting of the American Society for Bone and Mineral Research.

The researchers enrolled 173 patients after their first acute hip fracture. Of these, most (79%) were women. Their mean age was 84 years, and 77% were living in the community. Half (51%) of the patients had severe vitamin D deficiency with serum 25-hydroxyvitamin D levels below 30 nmol/L; almost all (98%) had serum 25-hydroxyvitamin D levels below 75 nmol/L.

Patients were randomized to receive extended physiotherapy or standard physiotherapy. Extended physiotherapy consisted of supervised therapy for 1 hour per day during acute care, plus an unsupervised home program of exercises to perform regularly for 1 year. The standard therapy consisted of supervised therapy for 30 minutes per day during acute care. Physiotherapy included activities such as getting up from a chair, one-leg stands, climbing up and down stairs, and a rubber band exercise program for upper arm strength.

Patients were also randomized to receive vitamin D supplementation at 2,000 IU or 800 IU vitamin D3 per day. All patients received calcium.

Clinical assessment, which included laboratory tests and functional evaluations, took place at baseline and at 6 and 12 months' follow-up. Falls and readmissions were assessed by monthly calls to patients, patient calls to a hotline, and patient diaries.

The primary end point was the rate of falls over 12 months. The secondary end point was the rate of hospital readmission over 12 months.

In all, 86 participants were included in the high-dose vitamin D group and 87 were included in the lower-dose vitamin D group; 87 participants were included in the extensive physiotherapy group, and 86 were included in the regular physiotherapy group. The groups did not differ by age, gender, BMI, cognitive function, baseline 25-hydroxyvitamin D levels, and Charleston Comorbidity Index scores.

The researchers documented 212 falls in 92 participants. Of these, 41% fell once, 26% fell twice, 19% fell three times, and 14% fell more than three times. The rate of falls per patient-year was 1.43. There were 22 new nonvertebral fractures, nine of which were in the contralateral hip.

There were 74 readmissions among 54 participants. Of these, 72% had one readmission, 20% had two, and 8% had three. The rate of readmission was 50%.

Extended physiotherapy reduced the rate of falls by 25%, compared with regular physiotherapy, a significant reduction. Similar improvements were seen in function. However, extended physiotherapy did not reduce the rate of hospital readmissions.

There was no difference in the fall rate for the two vitamin D groups, but high-dose vitamin D did reduce the rate of hospital readmission by 39%, which was significant. There was also a significant 60% reduction in fall-related injuries. “This was mainly driven by a nonsignificant reduction in repeat nonvertebral fractures by 52%,” said Dr. Bischoff-Ferrari of the Centre on Aging and Mobility at the University Hospital Zurich.

The rate of readmissions due to infections decreased a significant 90%. Fall-related injuries went down 47% (which was nonsignificant) among those in the extended physiotherapy group, a decrease primarily driven by a nonsignificant 56% reduction in repeat nonvertebral fractures, said Dr. Bischoff-Ferrari, who is also a visiting scientist in the Bone Metabolism Laboratory at Tufts University, Boston.

In the first year after a hip fracture, an estimated 5%-10% of patients fracture the other hip and 30% are readmitted to acute care. Half of these patients are left with permanent functional impairment, a quarter require long-term care, and 10%-25% die, she said.

Dr. Bischoff-Ferrari reported having no conflicts of interest.