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Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy.
Calcif Tissue Int. 2009 Oct; 85(4):301-9.CT

Abstract

To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Fisher A
Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia. alex.fisher@act.gov.au
Goh S
No affiliation info available
Srikusalanukul W
No affiliation info available
Davis M
No affiliation info available

MeSH

AgedAged, 80 and overBiomarkersCross-Sectional StudiesFemaleHip FracturesHospital MortalityHumansLength of StayMaleParathyroid HormonePrognosisProspective StudiesRegression AnalysisVitamin DVitamin D Deficiency

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19763373

Citation

Fisher, A, et al. "Elevated Serum PTH Is Independently Associated With Poor Outcomes in Older Patients With Hip Fracture and Vitamin D Inadequacy." Calcified Tissue International, vol. 85, no. 4, 2009, pp. 301-9.
Fisher A, Goh S, Srikusalanukul W, et al. Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcif Tissue Int. 2009;85(4):301-9.
Fisher, A., Goh, S., Srikusalanukul, W., & Davis, M. (2009). Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcified Tissue International, 85(4), 301-9. https://doi.org/10.1007/s00223-009-9283-1
Fisher A, et al. Elevated Serum PTH Is Independently Associated With Poor Outcomes in Older Patients With Hip Fracture and Vitamin D Inadequacy. Calcif Tissue Int. 2009;85(4):301-9. PubMed PMID: 19763373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. AU - Fisher,A, AU - Goh,S, AU - Srikusalanukul,W, AU - Davis,M, Y1 - 2009/09/11/ PY - 2009/04/07/received PY - 2009/08/12/accepted PY - 2009/9/19/entrez PY - 2009/9/19/pubmed PY - 2010/5/5/medline SP - 301 EP - 9 JF - Calcified tissue international JO - Calcif Tissue Int VL - 85 IS - 4 N2 - To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients. SN - 1432-0827 UR - https://www.unboundmedicine.com/medline/citation/19763373/Elevated_serum_PTH_is_independently_associated_with_poor_outcomes_in_older_patients_with_hip_fracture_and_vitamin_D_inadequacy_ L2 - https://dx.doi.org/10.1007/s00223-009-9283-1 DB - PRIME DP - Unbound Medicine ER -