Abstract
Introduction: Best practice tariff for Neck of Femur Fractures (NOFF) includes establishing a bone protection plan (BPP). Optimal management is often delayed due to insufficient vitamin D levels. Here we reviewed the administration of anti-resorptive (AR) therapies when giving vitamin D loading doses over 7 weeks compared to stat high dosing followed by maintenance therapy.
Method: Pre-intervention, we reviewed vitamin D levels, treatment given and bone protection therapy administered in all new NOFF admissions over 3 months. We introduced once-only high dose vitamin D therapy in deplete individuals over subsequent 3 months; deplete (Vit D <50) patients received 140,000 units stat colecalciferol, patients with insufficient levels(Vit D 50-70) received 60,000 units stat colecalciferol and replete individuals received adcal maintenance. Patients were given in-patient AR therapy or referred to fracture liaison service (FLS).
Results: Pre-intervention included 64 patients, of which 61% (N=39) had low vitamin D levels. These patients were loaded with once weekly 40,000 units of colecalciferol for 7 weeks and referred to FLS; 51% (N=24) received an appointment within 4 months. Only 14% (N=9) received in-patient AR treatment. Post intervention, 84 patients were reviewed. Vitamin D replacement was required in 69% (N=59) of patients, of which 83%(N=49) received the new loading regimen. This allowed 53% (N=20) of eligible patients to receive in-patient AR therapy.
Conclusion: Administrating high dose vitamin D to NOFF patients allowed us to increase in-patient AR therapy treatment 3.7 times. This simple intervention results in less out-patient appointments and treatment is given before opportunity to re-fracture.