Abstract
Adequate vitamin D and calcium supplementation therapy in osteoporosis reduces the
risk of fragility fractures and correlates with improved mortality outcomes in postoperative
fragility hip fracture patients. However, the prevalence of adequate supplementation
in this population remains unclear. Our purpose was to describe supplement use among
the adult population in United States who have been told they had osteoporosis and
identify factors associated with adequate supplementation, particularly in patients
with history of hip fracture. The study sample comprised a total of 15,968 respondents
from the National Health and Examinations Survey (NHANES 2007–2010, 2013–2014); 1,065
self-reported a diagnosis of osteoporosis and 266 self-reported a history of hip fracture.
Additional patient factors were analyzed by multivariable logistic regression to assess
associated factors of adequate vitamin D (≥ 600 international unit [IU]/day) and calcium
(≥ 1000 mg/day) supplementation. The prevalence of vitamin D and calcium supplementation
was significantly higher in the osteoporosis group than without (p = 0.001). However, supplemental intake reached adequate levels (≥ 600 IU/day of vitamin
D and ≥ 1000mg/day of calcium) in only 28.8% of individuals with osteoporosis for
vitamin D, 51.6% for calcium, and 19.2% for both. Of individuals with additional history
of hip fracture, only 14% reported adequate intake of both nutrients. Female sex (odds
ratio [OR]: 2.35, p < 0.001), older age (OR: 1.02, p < 0.001), and Caucasian race (OR: 1.456, p = 0.004) were positive factors of adequate supplementation, while Hispanic ethnicity
was a negative factor (OR: 0.658, p = 0.009). Unexpectedly, a history of hip fracture did not affect the odds of adequate
treatment (OR: 0.685, p = 0.176). Adults with known osteoporosis in the United States are self-reporting
inadequate supplementation therapy, and significant gender and racial disparities
exist. There is a broad need for improved supplementation to help manage this disease,
particularly among adults with prior hip fracture, a vulnerable population most relevant
for orthopaedic surgeons. This study serves as a call-to-action for orthopaedic surgeons
to ensure their fragility hip fracture patients receive adequate supplementation postoperatively
to maximize their health and recovery. This was a Level III, retrospective cohort
study.
Keywords
osteoporosis - fragility hip fracture - vitamin supplementation
