Hip Fractures and Vitamin D: Helpful or Not?

Marks Ray1

1 Department of Health and Behavior Studies, Columbia University, Teachers College, New York, NY 10027, USA

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Marks Ray, Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525W, 120th Street, New York, NY 10027.
Email: rm226@columbia.edu
Telephone: +1-212-678-3445
Fax: +1-212-678-8259

Received: June 5, 2021
Revised: July 3, 2021
Accepted: July 6 2021
Published online: August 28, 2021


BACKGROUND: Hip fractures have continued to be among the leading causes of excess morbidity and mortality rates among aging adults in all parts of the world for some time.

QUESTIONS: (1) Is the incidence and/or prevalence of hip fractures continuing to escalate given many efforts to improve bone and general health of older adults across the globe? (2) If so, will the use of vitamin D assist those at risk in some way?

METHODS: PUBMED was searched for related articles, especially those that were published between 2016-2021.

RESULTS: While hip fracture rates may have decreased in some locations over time, it is safe to say, they appear to remain highly important causes of disability in aging populations, which are increasing globally. Discordant findings on vitamin D persist however, although this substance seems helpful in some cases.

CONCLUSION: The body of research that examines vitamin D relative to hip fractures is largely non-conclusive as regards a) the deterministic role of vitamin D deficiency; b) the role of vitamin D supplementation. More clarity in these areas is indicated in light of the anticipated global increase in hip fractures numbers by 2050 and their disabling consequences and incalculable costs.

Key words: Aging; Hip Fractures; Prevalence; Prevention; Vitamin D

© 2021 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Marks R. Hip Fractures and Vitamin D: Helpful or Not? International Journal of Orthopaedics 2021; 8(4): 1518-1528 Available from: URL: http://www.ghrnet.org/index.php/ijo/article/view/3205


Many authors over the years have concluded that hip fractures, a highly common injury affecting many older adults, are strongly associated with significant morbidity and mortality rates[1-3], plus marked deficits in function and life quality among survivors[2,4], especially among men[5]. What is not agreed upon in this realm is whether this problem is increasing or decreasing. Moreover, if it is increasing, it remains unclear as to whether vitamin D is a factor explaining this. A third area of research focused on the actual outcomes of vitamin D supplementation, remains equally non uniform. Finally, whether surgeons should recommend vitamin D for fostering functional recovery or averting secondary hip fracture risk post-hip fracture surgery remains unclear.

At the same time, it appears that even if hip fracture rates have tended to decline in some countries in the recent past, globally, most countries are experiencing high rates of aging cohorts, as well as cohorts of higher ages than those previously studied. Thus, despite an apparent age-standardized incidence decline as regards hip fractures in several countries, it appears this may yet be outweighed by the extent of ageing across various populations, especially those with limited resources and populations living to higher ages. In this regard, predictions made recently do suggest that the global number of hip fractures can be expected to increase from 1.26 million in 1990 to 4.5 million by the year 2050[1].

This enormous rise in hip fracture cases that is anticipated over time does not include the new numbers that might emerge following COVID-19 pandemic situations, where many elderly were isolated, sedentary, and located indoors for prolonged periods. This group may also be less robust than groups assessed in prior years, and those sent home from hospital stays might be weaker, especially those who sustained a hip fracture during a lockdown period[6]. In any event, the anticipated total number of hip fractures predicted by 2050 clearly poses a significant global challenge to both healthcare systems and to older adults themselves according to Fernandez et al[7], and is one that should not be ignored. The fact that a hip fracture injury can prove extremely devastating to an aging individual[8,9], if they survive the trauma and surgery, surely stresses the need for implementing all possible strategies that have the potential to safely mitigate or minimize hip fracture risk, as well as the risk of suboptimal surgical outcomes, plus recurrent, second or third hip fractures.

Indeed, regardless of data source, and geography, the literature is quite consistent in identifying that hip fractures continue to have a substantial impact on older peoples’ physical abilities, quality of life, and adaptability[4] that has not diminished substantively in this regard over time, even though many forms of prevention have been discussed and implemented. In fact, the direct costs associated with this condition appear to have remained considerable because the injury often requires a long period of hospitalization and subsequent rehabilitation due to the possible associated development or exacerbation of other health conditions such as depression, osteoarthritis, and cardiovascular problems that may predictably pose additional costs, especially social costs[1].

In addition, Abrahamsen et al[10] who examined osteoporotic medication usage from 2005-2015 in Denmark concluded the observed plateau in usage of osteoporosis treatment at a level was probably too low to make a meaningful impact on the societal hip fracture burden given its predicted age-specific increase in the future, thus other avenues of intervention must remain open to scrutiny. As well, Tsuda et al[11] found the use of the much discussed bone building pharmacologic product or bi-phosphonates did not significantly reduce fracture risk unless patients had a prior fracture. Their effect in patients without prior fracture, who constitute most cases, thus, remains unclear. Similarly, exercise, or nutrition or multi level preventive approaches have failed to be universally impactful, applied, or even practical.

Specific aims

The specific aim of this present narrative review was to document whether hip fractures are likely to continue to be important disablers of the older adult in the future, and if so, whether vitamin D, a compound linked to bone health, muscle health, and overall well-being, is likely to be helpful in the context of both hip fracture prevention and rehabilitation. Since the available data are not clear on these points, we hoped to offer the reader an updated and comprehensive synthesis of what we know about the future of hip fracture injury rates, and whether vitamin D exposure can mitigate any aspect of the projected health burden, plus suggestions on how this data might be duly applied.


The key questions posed in this present review were: (1) Is there a need to continue to pursue preventive strategies against hip fractures in the older population? (2) If so, is there a role for vitamin D, and in what respect?


Hip fractures among the elderly pose a significant economic, social, and physical burden wherever they occur[1,12,13]. Moreover, as outlined by Haentjens et al[14], even after initial hospitalization, hip fractures continue to generate significant costs throughout the ensuing 12 months after discharge. Cost estimates based on data obtained prospectively from hip-fracture patients and matched controls also showed the costs associated with the treatment of hip-fractures to be about three times greater than those resulting from the treatments of age and residence-matched controls without a fracture. Thus it is clear that hip fracture prevention is a topic of immense import that clearly warrants attention, and in particular, warrants clarification as to whether vitamin D, of key import in the context of osteoporosis, a hip fracture determinant[15], is of current relevance in this regard as discussed for some time with conflicting conclusions[16,17].


To examine whether hip fractures remain a major health concern in a global context, and whether vitamin D is potentially of clinical relevance in the context of hip fractures prevention efforts, all pertinent articles listed on PUBMED that appeared to inform about hip fractures and/or vitamin D were sought and those of high relevance were examined specifically. A scan of the epidemiological data from different countries was also undertaken, and the nature of any predicted trend in coming decades was summarized as being either declining in nature or likely to increase. Then, regardless of trends, evidence to support a focus on hip fracture prevention was sought. As well, the specific role of vitamin D in influencing hip fracture risk, and its possible utility in preventive situations was examined. Finally, studies detailing the consequences of hip fracture surgery and the degree to which vitamin D applications may be warranted in this regard were undertaken.

Articles selected for independent assessment had to focus on vitamin D and hip fractures, or hip fractures and their outcomes as published between 2016-2021. Excluded were non-clinical studies, preprints, abstracts, and conference proceedings. The PUBMED data base was chosen to represent a majority of the works on the present topic published to date. Articles were screened for their relevance and data addressing the review questions were duly extracted, regardless of study approach. We accepted the fact many studies included in the data base were observational or of possible low quality, but that these might have some important clinical utility, nonetheless. Even when considering only prospective data, the diverse approaches and questions studied were deemed very challenging to aggregate, hence no definitive statistical analyses were conducted. In this regard, and among those articles that met criteria for discussing prevalence issues, we excluded those that did not provide future 2025-2050 projections. From those reports that met citeria, we elected to tabulate the key anticipated trends in upcoming decades, where available.

In light of present space limitations, and the fact we sought to narrate data largely from 2016-2021, readers may want to examine those hip fracture trends that occurred between 2010-2019 by referring to the paper by Peng et al[18]. Those who wish to examine comparable hip fracture data covering the periods from 1980-2009 are referred to the detailed review by Marks[19].


General findings

As of June 5, 2021, and highlighted in Table 1, it appears a considerable level of substantive and continuing interest in the context of efforts to better understand hip fractures, their occurrence, and modes of prevention and outcomes has prevailed since the 1960s. Among those that detail future hip fracture trends, most indicate a need for continued study (Table 2).

Table 1 Table depicting search terms and their relative results concerning the current topic.
Number of reportsNumber in last 5 yearsNumber in past year [2020-2021]
Vitamin D90584231335564
Hip Fractures40,50096732477
Hip Fracture Prevalence128193802820
Hip Fracture Outcomes1348251701432
Vitamin D + Hip Fractures1932380103
Note: 1) Commonly, these report numbers do not accurately reflect the topical information sought and are generally all overestimates as a result; 2) most systematic reviews rarely discuss contemporary or comparable data for example, ages, geographic regions, injury type, modes of assessment.

Table 2 Summary of projections for hip fracture occurrences by 2050.
AuthorsGeographic Location/YearKey Anticipated Predictions for Hip Fracture Rates 2025-2050
Concin et al. [21]Austria, 2015By 2050, case rates assessed in 2015 will have more than doubled, regardless of gender
Ramanau et al. [22]Belarus, 2015The estimated number of hip fractures in persons older than 50 will increase substantially by 2050
Kirilova et al. [23]Bulgaria, 2015In adults 50 years of age and above, hip fracture numbers of 9322 in 2015 will likely increase to 11,398 in 2050
Kebatse et al. [24]Botswana, 2020The estimated number of hip fractures nationwide in persons over age 50+ for 2020 of 103 is predicted to increase to 372 in 2050
Diaz-Ledzma et al. [25]ChileFor 2030, hip fractures among the elderly population are projected to grow 27.5% to 9862 cases
Gong et al. [26]ChinaBy 2050, the total number of hip fractures in people older than 65 years in China is predicted to be 1.3 million
Ong et al. [27]GlobalBy 2050, it is estimated six million hip fractures will occur annually and the majority will be in Asia
Cooper et al. [28]Global, 1990Hip fracture numbers will increase from 1.66 million observed in 1990 to 6.26 million by 2050
Veronese and Maggi [1]GlobalHip fracture numbers will increase from 1.26 million in 1990 to 4.5 million by 2050
Downey et al. [29]IrelandThe number of fragility hip fractures in adults >60 years is estimated to triple/quadruple by 2050
Barrios-Moyana et al. [30]Mexico, 2009According to figures from 2009, 1/12 Mexican women and 1/20 men over age 65 will suffer a hip fracture when cases reach 110,055 patients in the year 2050
Lesnyak et al. [31]Kyrgyz Republic, 2015An estimated 2752 hip fractures in 2015 will increase by 207% to 8435 in 2050
Issayeva et al. [32]Kazakhstan, 20152015 data estimates of 11,690 in 2015 are predicted to increase by 140% to 28,000 in 2050
Zakroyeva et al. [33]Moldova, 2015The 2015 data reflecting 3911 hip fracture cases will increase by 60% to 6492 in 2050
Naureen et al. [34]Pakistan, 2015An estimated 36,524 hip fractures in 2015 will increase by 214% to 114,820 in 2050
Kim et al. [35]South Korea, 2008Hip fractures increases from 159.1/100,000 in 2008 to 181.5/100,000 in 2012, are estimated to increase by 1.4 times over the next 10 years
Wilk et al. [36]PolandThere will be an increase of a total crude rate of 467.2 (men 329.6; women 584.7) for the year 2050
Tuzun et al. [37]TurkeyThe number of hip fractures is expected to increase to nearly 64,000 in 2035
Abeygunasekara et al. [38]Sri LankaAccording to the data, 3824 hip fractures would have occurred island-wide during the study period and will likely reach 12,068 in 2051
Leznyk et al. [39]Uzbekistan, 2015Estimated numbers of hip fractures in persons 50+ years for 2015 of 16,764 are predicted to increase to 60,272 in 2050
Note: In general, most of these reports and others discuss hip fracture incidence and prevalence rates that are not necessarily current [eg., 20, 31-35, 40-45, 49].

Specific findings

Hip fracture trends and costs

The presently available research articles covering the time periods 2016-2021 strongly indicate that hip fractures will continue to pose an enormous challenge to health policy makers and others over the next few decades, despite some evidence of declining hip fracture incidence rates in some regions in recent years [eg., 20, 40, 45-49]. In particular, selected population trend estimates conducted largely prior to 2016, can be said to generally show that regardless of geographic location, or declining or low rates of hip fracture rates in the past, hip fractures will continue to increase in numbers up until at least 2050 in those regions studied. This seems especially evident in the case of men as well as those in the higher age groups that exhibit frailty or multiple coexisting diseases, health conditions thought to be increasing among aging populations in their own right[21,50-52].

Unsurprisingly, former ‘low risk’ countries such as China expect rising trends, especially in remote high altitude regions in the future[26]. Data may also be underestimates or inaccurate for countries that have taken concerted preventive measures and still tend to show benefits in research reports as of 2021, such as Taiwan until 2012[47], and Japan up until 2017[45,52-53], if current data sets fail to represent the changing nature of the aging population and its health status, in the face of anticipated widespread frailty increases, along with multi morbidities in the increasingly prevalent older age groups. The incidence rates applied to provide base line calculations in predictive models may also fail to depict more recent upward trends of relevance to fracture risk, such as increases in rates of osteoporosis, as well as how specific sub groups appear to be at higher risk than others[48]. In the Kyoto Prefecture for example. Asada et al[48] found the number of hip fractures to increase in the second half of their study period (2013-2017) compared to the first half (2008-2012), a finding similar to Lin et al[54] in Taiwan where there was a temporal trend of a 8.6% increase in the incidence of all types of hip fractures over the period of 2000-2010, yet, the incidence rate did not increase, with the exception of femoral neck fractures in men aged ≥ 75 and women aged ≥ 85.

Ha et al[55] who calculated projections of future hip fracture occurrences in Korea using the Poisson distribution and data from 2016 to 2025, implied the incidence of hip fractures in Korea will continue to increase, along with its socioeconomic burden, a conclusion echoed by Glinkowski et al[56] who collected data between 2008 and 2015 in Poland. Rapp et al[3] who conducted a thorough review of hip fracture incidence rates showed that while hip fracture rates tend to vary more than 100-fold between different countries, it appears not all have shown a a decrease in hip fracture rates over time even if they are considered high income locations such as Germany[3]. In addition, a recent study conducted in China by Zhang et al[42] showed that despite stable hip fracture incidence rates from 2012-2016, actual numbers of hip fracture injuries increased in parallel with the aging of the population. That is, the absolute number of hip fractures in those 55 years and older increased about 4-fold, and accordingly, the total costs for hospitalization showed a steep rise from US$60 million to US$380 million over the study period. As well, costs of hospitalization increased about 1.59-fold, from US$4,300 in 2012 to US$6,840 in 2016. These data may yet be underestimates because they did not necessarily account for the possible recurrence of the fracture at the initial injury site, or the development of a new fracture in the contra-lateral hip, that may occur in almost 10 percent of hip fracture survivors[57]. As well, regardless of case numbers, mortality rates post hip fracture remain high, especially for men[58], and according to Hagen et al[47], estimates of health lost to hip fractures will approximately double, from 32,850 DALYs in 2020 to 60,555 in 2040 in Norway, even though hip fracture incidence rates were found to be decreasing in the high incidence area of Oslo, Norway, among women[59].

In short, in terms of the anticipated increases in coming decades of increasingly high hip fracture volumes and their dire consequences, as discussed by Von Friesendorff et al[60], and when considering these injuries solely from a remaining lifetime perspective, it can be anticipated that post fracture all-cause and excess mortality rates will probably continue to be higher rather than lower, even after 20 years of follow-up if no comprehensive preventive programs are forthcoming in the immediate future. As well, Veronese and Maggi[1] too have noted hip fracture recovery to be commonly associated with highly negative health consequences, such as disability, depression, and cardiovascular diseases, as well as immense social costs, and these are expected to continue in the absence of dedicated preventive approaches and efforts. Moreover, as discussed by Dyer et al[4] the long-term outlook for hip fracture surgery survivors even those deemed initially independent in self-care pre-fracture, is bleak, and one where 20-60% of survivors will likely require assistance for various daily tasks for up to two years, especially in the older age groups and those with fragility fractures. Moreover, among those elderly living in residential care, which they may be forced to reside in post hip fracture, their level of function is likely to be lower than those returning to and living in the community. As per Papadimitrou et al[61], hip fracture injuries, which are found to increase in prevalence with age[62], can also be expected to lead to a substantial loss of years of healthy life even in previously healthy older adults, in addition to producing substantive decrements in independence and mobility in the first year post fracture, along with an increase risk of depressive symptoms and a decrease in activity participation[63].

In addition, high mortality rates within the first three to six months of their injury in surgical cases are common[64], and may be even higher in non-operative cases, or in those receiving poorly integrated care[65-68]. Moreover, as well as a possible heightened risk for a second hip fracture[69], those hip fractures cases with sarcopenia can be expected to have very poor functional outcomes[70], as well as high levels of psychological distress[71]. Along with excess mortality rates in the first post surgical year[72], hip fracture survivors may hence experience a highly reduced health-related life quality, and will be unlikely to return to their pre-fracture levels of performance without dedicated efforts to achieve this[73].

Hip fracture determinants and vitamin D

In light of the high magnitude of excess disability and premature death rates associated with hip fractures, along with the failure of current modes of intervention to prevent this set of debilitating outcomes in most cases, it appears crucial to re examine whether the predicted 2050 predicted tsunami of death and distress due to this injury can be averted to some degree. These include, but are not limited to, a multitude of potentially remediable factors uncovered since the 1960s, including falls, low bone and muscle mass, chronic health conditions, impaired cognitions, low milk consumption, suboptimal exposure to sunlight, and vitamin D deficiency. Others include environmental and social factors, vision impairments, disability, neurological impairments, steroid usage, and medication effects[19,74-80].

However, in the specific case of vitamin D, much conflict prevails, even though most hip fracture cases are found to be vitamin D deficient, and despite a strong rationale from basic research studies and others that vitamin D plays a key or important role in bone physiology and maintenance, muscle physiology, overall health status, and possibly in cognitive and falls associated situations. As well, many, although not all epidemiological studies suggest that vitamin D insufficiency is related to a number of other disorders frequently observed among elderly fallers who are prone towards hip fracture, such as type 2 diabetes, and cardiovascular disorders including hypertension. See Table 3 for representative summary data on this issue.

In short, as per Table 3, and discussed by Salaman et al[104] even though ample evidence supports the presence of vitamin D in maintaining calcium and bone metabolism, a risk factor of osteoporosis, falls and fracture in old age, its replacement seems to have differential effects or no effects as regards hip fracture risk, survival, or recovery.

Table 3 Randomly selected research examples of possible relevant findings concerning vitamin D and hip fracture interactions showing possible areas of promise for future study, despite no effects of usage by some.
Research groups Findings and Conclusions
Aventi et al. [81]Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. Supplements of vitamin D and calcium may prevent hip or any type of fracture .
Chutterpaul et al. [82]The high prevalence of vitamin D deficiency and/or insufficiency in the hip fracture cohort studied strongly implies a need for universal vitamin D supplementation in older adults, especially those at risk for osteoporotic fractures
Dadra et al. [83]The prevalence of vitamin D deficiency was found to be very high in patients with hip fragility (proximal femur) fractures in 75% cases studied
Dretkakis et al. [84]Older age, recurrent falls, and severe vitamin D deficiency were found to be associated with trochanteric fractures. Additionally, older age, female gender, and severe vitamin D deficiency were related to recurrent falls
Han et al. [85]Vitamin D deficiency and inadequacy were high in patients with low-energy hip fractures, with only 4.9% of patients having normal vitamin D levels
Jamal et al. [86]There is a significant association between the presence of a vitamin D deficiency and the severity of intertrochanteric fractures (p <0.05), in both genders
Niikuru et al. [87]Perennial vitamin D insufficiency was found to be prevalent in elderly Japanese hip fractures cases
Yao et al. [88]Daily supplementation with both vitamin D and calcium appears somewhat promising
Lai et al. [89]Neither higher nor lower dose vitamin D supplementation prevents hip fracture
Reid et al. [90]Widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems inappropriate
Poole et al. [91]Using only a 1-year horizon, considering only reduction in hip fracture, prescribing 800 IU of vitamin D daily to all adults aged 65 and over, could reduce the number of incident hip fractures from 65,400 to 45,700, saving almost 1,700 associated deaths, whilst saving the United Kingdom taxpayers £22 million
Sim et al. [92]Preoperative severe vitamin D deficiency is an independent risk factor for poorer recovery of function and quality of life after hip fracture surgery.
Thorpe et al. [93]Without combined supplementation of both vitamin D and calcium, female vegans are at high risk of hip fracture
Wang et al. [94]Compared to low serum vitamin D levels, high serum vitamin D levels reduced the risk of hip fractures in patients aged 60?years or older, but not total fracture risk
Whiting et al. [95]In long term care homes, vitamin D had no observable effect on those hip fracture patients who used vitamin D. Models for mortality, stratified by sex, showed in women only, that vitamin D use resulted in a significant inverse association with time to death [HR (0.91(0.87-0.96)] ; for men it was 0.94(0.88-1.01) . The impact of vitamin D supplementation in long term care contexts deserves further investigation
Weaver et al. [96]This meta-analysis of randomized controlled trails supported the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults
Zhao et al. [97]Levels of vitamin D were significantly associated with the severity of intertrochanteric, but not femoral neck, fractures
Zhang ET AL. [98]Vitamin D deficiency precipitates and exacerbates osteoporosis among adults and causes the painful bone disease called osteomalacia. Osteoporosis is a systemic skeletal disease characterized by decreased bone strength and increased risk of fractures
Zhao et al. [99]The use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults
Steingrimsdottir et al. [100]Results lend support to the overarching importance of maintaining serum vitamin D levels above 30 nmol/L
Yu et al. [101]Vitamin D deficiency is common in patients with brittle hip fractures, especially in women. With the increase of age, vitamin D continues to decrease and parathyroid hormone increases. The decrease of bone mineral density in patients with hip fractures is the result of a combination of age, gender, body mass, and vitamin D content
Neale et al. [102]Even in sunny Australia, vitamin D deficiency contributed to a considerable number of hospitalizations as a consequence of falls and for treatment of hip fracture in older
Conley et al. [103]To prevent secondary hip fractures, adequate dietary or supplemental vitamin D and calcium intake should be assured

Additional Findings

In line with the selected findings outlined in Table 3, data collected by Dhanwahl et al[105] have shown almost 75% of admitted hip fracture cases currently can be expected to exhibit a vitamin D deficiency. An even higher rate of 96.7% of hip fracture cases were found to be vitamin D deficient however, in an Asian-Indian cohort with fragility hip fracture, and where the bone mineral density of these patients was also significantly lower than that of age and sex matched healthy controls[77]. This is important because as noted by Zhao et al[106], cases suffering from inter trochanteric hip fracture who exhibited with lower vitamin D levels were found to have more severe fractures than those with higher levels. They may also exhibit more evidence of post-operative delirium, more new hip fractures, and more medical readmissions, at 1 year[107], unless action to counter this is forthcoming[108].

Although supplementation of vitamin D is not currently advocated for all hip fracture cases, Jarusswan et al[109] have concluded that in treatment settings where baseline serum vitamin D level can’t be evaluated in older adults with fragility hip fracture, high-dose vitamin D2 of approximately 60,000 IU/week for 12 weeks, with a subsequent switch to a maintenance dose is likely to prove beneficial because this regimen can effectively restore serum vitamin D to optimal levels in 82.8% of patients without causing symptomatic hypercalcemia.

Mak et al[110] who conducted a randomized, double-blind, placebo-controlled trial of 218 adults, aged 65-years or older, requiring hip fracture surgery who were assigned to receive a single loading-dose of vitamin D (250,000 IU vitamin-D3, termed the REVITAHIP - Replenishment of Vitamin D in Hip Fracture strategy) or placebo, and who both received daily vitamin-D (800 IU) and calcium (500 mg) supplements for 26-weeks, did find falls related benefits in the active group at week 4. As well, a higher percentage of the active group reported ‘no pain or consistent discomfort’, and trended for higher life quality scores at week-26.

Sprague et al[111] who used data from a large hip fracture trial to determine the proportion of patients who used vitamin D after hip fracture surgery and whether supplementation was associated with improved health-related quality of life and reduced reoperation rates found that despite guidelines recommending vitamin D supplementation, a low proportion of elderly patients with hip fracture were using vitamin D consistently, suggesting a need for additional strategies to promote compliance if this is indicated. The authors of this study also found vitamin D usage to be associated with significant improvements in health-related quality of life after sustaining a hip fracture. It also appears that vitamin D supplements may be more helpful than not in selected cases with fragility fractures who may have a severe vitamin D deficiency, and a high risk of significantly poorer baseline and 6-month outcomes[92,108] post hip fracture surgery than those with adequate vitamin D levels. As well, higher one year and four year survival rates may be evidenced if vitamin D supplementation is coupled with exercise[115].


This review examined whether hip fractures remain a noteworthy cause of excess morbidity and mortality among older adults, and if so, if there is a need to prevent the injury and its consequences. It also examined the possible role of vitamin D in this regard. Using data published primarily between 2016 and 2021, it seems most nations can clearly anticipate increases, rather than decreases in hip fractures case rates by 2050, regardless of geographic location or prior successes in reducing hip fracture rates. At the same time, many aging adults will be likely to be in poor health with deficient vitamin D levels and at high risk for fracturing a hip, a potentially devastating event[79].

Yet, although a strong case can be made for vitamin D, a steroid hormone involved in bone physiology and a substance possibly implicated in the hip fracture risk cycle, this area of research remains unproven and conflicting reports prevail. Indeed, despite the urgency of this issue, a very limited numbers of research projects from limited geographical locations prevail, some using retrospective data or observational approaches.

Further, very few clinical controlled studies prevail, and many suffer from low quality or questionable efforts to aggregate dissimilar data sets. As such, and in light of the very modest successes of past preventive approaches, and a trend to more rather than less favourable role for vitamin D in hip fracture prevention efforts, more should clearly be done in the future, especially in the less developed world[39,42,113] to examine vitamin D and its presence in the serum and how this might be harnessed to play an important preventive role in the context of hip fracture risk, and recovery, as outlined by Chevalley et al[114].

At the same time, and according to Bischoff-Ferrari[115] given that about two-thirds of hip fracture cases may show signs of a vitamin D insufficiency, and a recent review indicated its possible benefits in averting hip fractures due to falls[116], as well as in improving health and extra-skeletal health status[117], in the event the older adult is deficient in vitamin D, it seems this possible avenue of mitigation and causality should not be ignored or need to await future study. Accordingly, and notwithstanding the lack of any robust evidence to validate universal supplementation of vitamin D among the older at risk population, in addition to encouraging the use of sound safety measures against falls[78], appropriate routine screening measures to determine the prevailing level of serum vitamin D in vulnerable older adults, along with timely follow up procedures by practitioners may not only help to identify those at risk elderly people who should clearly be targeted, but may alleviate much distress and pain, and may even save lives.

In particular, as discussed by Downey et al[29], since the number of fragility hip fractures in adults 60 years of age or older is estimated to triple or quadruple by 2050, with an estimated global cost of hip fractures in the year 2050 of $130 billion[118], the possible favorable role of vitamin D supplements in mitigating this to some degree, as indicated, must surely warrant widespread consideration. Indeed, since it is also estimated that the prevalence of contra-lateral hip fractures are expected to increase as well by 2050, more emphasis on all preventive possibilities against both primary as well as secondary hip fractures is not just a theoretical ideal, but one that is possibly an absolute requirement to have any chance of staving off the extent of the anticipated associated hip fracture injury burden in the future, including the presence and persistence of postoperative pain associated with osteoporotic hip fractures[8] and further surgeries for secondary hip fractures[103].

To resolve the discrepancies in the literature, as well as limitations of these due to lack of comparability and low quality evidence, key issues that might be valuable to address in a more consistent fashion in future efforts to garner a better understanding of these issues are- the nature of the methods of measuring and classifying vitamin D, the nature of the injury, pre-existing health status, and follow-up periods and procedures, the demographic features and geographical location of the sample studied, the duration of the follow-up periods, where published-plus attention to seasonal variations in vitamin D levels and activities[119]. In addition, careful consideration of the individual’s level of outdoor exposure, nutrient intake and access, falls history, and extent of frailty warrants careful attention in intervention studies. A specific focus on examining and differentiating between the causes and outcomes of the two main types of hip fractures, namely cervical and intertrochanteric fractures, especially in the context of vitamin D and its potential role in preventing and treating hip fractures also appears highly desirable. Nyugen and Lui[118] further imply that to enable more effective implementation and outcomes of hip fracture prevention strategies, it is imperative to develop an optimal model of care for older patients with hip fracture, especially in rapidly aging nations. Unfortunately, although a substantive number of authors identify high predicted magnitudes of hip fractures in 2050 among older adults, very few authors spelled out the implications of these associated dire prognostic conclusions, and only a very few mentioned any strategy or need to intervene on this future possible epidemic[eg 3,26].

However in light of the undisputed and severe individual and economic consequences of hip fractures, and their adverse influence on health care utilization, premature mortality, independence and life quality, it seems reasonable to consider all possible efforts to offset this burden and to do this by extending available research concerning the most salient risk factors underlying this condition that can be subjected to practical and widespread measurement and remediation. There is also a need to investigate whether it is possible to improve upon current rehabilitation strategies for restoring functional recovery post-hip fracture surgery, particularly for preventing second hip fractures and third hip fractures and certain types of articular degeneration, and extensive disability. Based on a considerable volume of supportive literature and biological rationale, vitamin D may be one factor worthy of consideration due to its possible impact on: (1) Bone mineral content/bone metabolism; (2) Balance/walking speed; (3) Effectiveness of protective reflexes; (4) Chronic pain; (5) Muscle strength/mobility; (6) The risk of falls and falling; (7) Extra skeletal health status; (8) Cognitive health status.

Ideas provided by researchers that may be especially worthy of consideration in efforts to minimize anticipated hip fracture 2050 rates of occurrence and their consequences include the need for: (1) Prompt action to counteract predicted global hip fracture increases[21,27]; (2) More effective falls and other practical prevention and safety approaches[78,118]; (3) More intense efforts to offset vitamin D deficiencies, bone fragility, and frailty[102-103,120-122].


1. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018; 49(8): 1458-1460. [PMID: 29699731]; [DOI: 10.1016/j.injury.2018.04.015].

2. Ramponi DR, Kaufmann J, Drahnak G. Hip fractures. Adv Emerg Nurs J. 2018; 40(1): 8-15. [PMID: 29384769]; [DOI: 10.1097/TME.0000000000000180].

3. Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2019; 52(1): 10-16. [PMID: 29594444]; [DOI: 10.1007/s00391-018-1382-z]

4. Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C; Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016; 16(1): 158. [PMID: 27590604]; [DOI: 10.1186/s12877-016-0332-0]

5. Skuladottir SS, Gudmundsdottir E, Mogensen B, Masdottir HR, Gudmundsdottir H, Jonsdottir LA, Sigurthorsdottir I, Torfadottir JE, Thorsteinsdottir T. Hip fractures among older people in Iceland between 2008 and 2012. Int J Orthop Trauma Nurs. 2019; 32: 27-31. [PMID: 30030062]; [DOI: 10.1016/j.ijotn.2018.06.001]

6. Kayani B, Onochie E, Patil V, Begum F, Cuthbert R, Ferguson D, Bhamra JS, Sharma A, Bates P, Haddad FS. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures. Bone Joint J. 2020; 102-B(9): 1136-1145. [PMID: 32634023]; [DOI: 10.1302/0301-620X.102B9.BJJ-2020-1127.R1].

7. Fernandez MA, Costa ML. Clinical research in fragility fractures. Injury. 2018; 49(8): 1473-1476. [PMID: 29958685]; [DOI: 10.1016/j.injury.2018.06.035]

8. Goto K, Kataoka H, Honda A, Yamashita J, Morita K, Hirase T, Sakamoto J, Okita M. Factors affecting persistent postoperative pain in patients with hip fractures. Pain Res Manag. 2020; 2020: 8814290. [PMID: 33204378]; [DOI: 10.1155/2020/8814290].

9. Barrios-Moyano A, Contreras-Mendoza EG. Frequency of complications in patients older than 60 years with hip fracture. Acta Ortop Mex. 2018; 32(2): 65-69. Spanish. [PMID: 30182550].

10. Abrahamsen B, Skjødt MK, Vestergaard P. Hip fracture rates and time trends in use of anti-osteoporosis medications in Denmark for the period 2005 to 2015: Missed opportunities in fracture prevention. Bone. 2019; 120: 476-481. [PMID: 30583122]; [DOI: 10.1016/j.bone.2018.12.016].

11. Tsuda T, Hashimoto Y, Okamoto Y, Ando W, Ebina K. Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention. J Bone Miner Metab. 2020; 38(5): 678-686. [PMID: 32236684]; [DOI: 10.1007/s00774-020-01096-z].

12. Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J. Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int. 2017; 28(10): 2791-2800. [PMID: 28748387]; [DOI: 10.1007/s00198-017-4153-6].

13. Kanters TA, van de Ree CLP, de Jongh MAC, Gosens T, Hakkaart-van Roijen L. Burden of illness of hip fractures in elderly Dutch patients. Arch Osteoporos. 2020; 15(1): 11. [PMID: 31897865]; [DOI: 10.1007/s11657-019-0678-y].

14. Haentjens P, Lamraski G, Boonen S. Costs and consequences of hip fracture occurrence in old age: an economic perspective. Disabil Rehabil. 2005; 27(18-19): 1129-1141. [PMID: 16278182]; [DOI: 10.1080/09638280500055529].

15. Capozzi A, Scambia G, Lello S. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas. 2020; 140: 55-63. [PMID: 32972636]; [DOI: 10.1016/j.maturitas.2020.05.020].

16. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005; 293(18): 2257-2264. [PMID: 15886381]; [DOI: 10.1001/jama.293.18.2257].

17. Kahwati LC, LeBlanc E, Weber RP, Giger K, Clark R, Suvada K, Guisinger A, Viswanathan M.. Screening for vitamin D deficiency in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021; 325(14): 1443-1463. [PMID: 33900706]; [DOI:10.1001/jama.2020.26498].

18. Peng G, Guan Z, Hou Y, Gao J, Rao W, Yuan X, Guo J, Huang X, Zhong Z, Lin J.. Depicting developing trend and core knowledge of hip fracture research: a bibliometric and visualised analysis. J Orthop Surg Res. 2021; 16(1): 174. 2021 Mar 4. [PMID: 33663568]; [DOI:10.1186/s13018-021-02292-x].

19. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010; 3: 1-17. [PMID: 20463818].

20. Meagher E, Varghese S, Harty JA, O’Loughlin PF. The decline of hip fracture incidence rates over a 10-year period: a single centre experience. Injury. 2021; 52(7): 1807-1812. [PMID: 33941386]; [DOI: 10.1016/j.injury.2021.04.051].

21. Concin H, Brozek W, Benedetto KP, Häfele H, Kopf J, Bärenzung T, Schnetzer R, Schenk C, Stimpfl E, Waheed-Hutter U, Ulmer H, Rapp K, Zwettler E, Nagel G. Hip fracture incidence 2003-2013 and projected cases until 2050 in Austria: a population-based study. Int J Public Health. 2016; 61(9): 1021-1030. [PMID: 27549873.]; [DOI: 10.1007/s00038-016-0878-9].

22. Ramanau H, Chernyanin I, Rudenka E, Lesnyak O, Zakroyeva A, Bilezikian JP, Johansson H, Harvey NC, McCloskey EV, Kanis JA. Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighboring country models. Arch Osteoporos. 2018; 13(1): 42. [PMID: 29666948]; [DOI: 10.1007/s11657-018-0454-4].

23. Kirilova E, Johansson H, Kirilov N, Vladeva S, Petranova T, Kolarov Z, Liu E,Lorentzon M, Vandenput L, Harvey NC, McCloskey E, Kanis JA. Epidemiology of hip fractures in Bulgaria: development of a country-specific FRAX model. Arch Osteoporos. 2020; 15(1): 28. [PMID:32108268]; [DOI: 10.1007/s11657-020-0710-2]

24. Kebaetse M, Nkhwa S, Mogodi M, Masunge J, Gureja YP, Ramabu M, Mmopelwa T, Sharif I, Orford A, Johansson H, Harvey NC, McCloskey EV, Cauley JA, Kanis JA. Epidemiology of hip fracture in Botswana. Arch Osteoporos. 2021; 16(1): 24. [PMID: 33550503]; [DOI: 10.1007/s11657-021-00885-x].

25. Diaz-Ledezma C, Bengoa F, Dabed D, Rojas N, López A. Hip fractures in the elderly Chilean population: a projection for 2030. Arch Osteoporos. 2020; 15(1): 116. [PMID: 32720199]; [DOI: 10.1007/s11657-020-00794-5].

26. Gong XF, Li XP, Zhang LX, Center JR, Bliuc D, Shi Y, Wang HB, He L, Wu XB. Current status and distribution of hip fractures among older adults in China. Osteoporos Int. 2021 Mar 2. [PMID: 33655399]; [DOI: 10.1007/s00198-021-05849-y].

27. Ong T, Khor HM, Kumar CS, Singh S, Chong E, Ganthel K, Lee JK. The current and future challenges of hip fracture management in Malaysia. Malays Orthop J. 2020; 14(3): 16-21. [PMID: 33403058]; [DOI: 10.5704/MOJ.2011.004].

28. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992; 2(6): 28528-9. [PMID: 1421796]; [DOI: 10.1007/BF01623184].

29. Downey C, Flannery S, Abd Wahab EH, Askin D, O’Kelly P, Shortt CP, O’Daly BJ, Quinlan JF. The patient’s second hip fracture - one in ten. Ir Med J. 2020; 113(6): 93. [PMID: 32816428].

30. Barrios-Moyano A, Contreras-Mendoza EG. Frequency of complications in patients older than 60 years with hip fracture. Acta Ortop Mex. 2018; 32(2): 65-69. Spanish. [PMID: 30182550]

31. Lesnyak O, Zakroyeva A, Lobanchenko O, Johansson H, Liu E, Lorentzon M, Harvey NC, McCloskey E, Kanis JA. A surrogate FRAX model for the Kyrgyz Republic. Arch Osteoporos. 2020; 15(1): 68. [PMID: 32377964]; [DOI: 10.1007/s11657-020-00743-2].

32. Issayeva S, Lesnyak O, Zakroyeva A, Issayeva B, Dilmanova D, Johansson H, Liu E, Lorentzon M, Harvey NC, McCloskey E, Kanis JA. Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model. Arch Osteoporos. 2020; 15(1): 30. [PMID 32108270]; [DOI: 10.1007/s11657-020-0701-3].

33. Zakroyeva A, Lesnyak O, Cazac V, Groppa L, Russu E, Chislari L, Rotaru L, Johansson H, Harvey NC, McCloskey E, Lorentzon M, Kanis JA. Epidemiology of osteoporotic fracture in Moldova and development of a country-specific FRAX model. Arch Osteoporos. 2020; 15(1): 13. [PMID: 31993755]; [DOI: 10.1007/s11657-019-0669-z].

34. Naureen G, Johansson H, Iqbal R, Jafri L, Khan AH, Umer M, Liu E, Vandenput L, Lorentzon M, Harvey NC, McCloskey EV, Kanis JA. A surrogate FRAX model for Pakistan. Arch Osteoporos. 2021; 16(1): 34. [PMID: 33595723]; [DOI: 10.1007/s11657-021-00894-w].

35. Kim BS, Lim JY, Ha YC. Recent epidemiology of hip fractures in South Korea. Hip Pelvis. 2020; 32(3): 119-124. [PMID: 32953703]; [DOI: 10.5371/hp.2020.32.3.119].

36. Wilk R, Skrzypek M, Kowalska M, Kusz D, Koczy B, Zagórski P, Pluskiewicz W. The 13-year observation of hip fracture in Poland-worrying trend and prognosis for the future. Aging Clin Exp Res. 2018; 30(1): 61-69. [PMID: 28353218]; [DOI: 10.1007/s40520-017-0747-2].

37. Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, KanisJA; Turkish Osteoporosis Society. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012; 23(3): 949-955. [PMID:21594756]; [DOI: 10.1007/s00198-011-1655-5].

38. Abeygunasekara T, Lekamwasam S, Lenora J, Alwis G. Current incidence andfuture projections of fragility hip fractures in Sri Lanka. Arch Osteoporos.2020; 15(1): 178. [PMID: 33169284]; [DOI: 10.1007/s11657-020-00848-8].

39. Lesnyak O, Ismailov S, Shakirova M, Alikhanova N, Zakroyeva A, Abboskhujaeva L, Johansson H, Harvey NC, McCloskey E, Kanis JA. Epidemiology of hip fracture and the development of a FRAX model for Uzbekistan. Arch Osteoporos. 2020; 15(1): 119. [PMID: 32728952]; [DOI: 10.1007/s11657-020-00792-7].

40. Lewiecki EM, Wright NC, Curtis JR, Siris E, Gagel RF, Saag KG, Singer AJ, Steven PM, Adler RA. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018; 29(3): 717-722. [DOI: 10.1007/s00198-017-4345-0].

41. Hagen G, Magnussen J, Tell G, Omsland T. Estimating the future burden of hip fractures in Norway. A NOREPOS study. Bone. 2020; 131: 115156. [PMID: 31760216]; [DOI: 10.1016/j.bone.2019.115156].

42. Zhang C, Feng J, Wang S, Gao P, Xu L, Zhu J, Jia J, Liu L, Liu G, Wang J, Zhan S, Song C. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med. 2020; 17(8): e1003180. [PMID: 32760065]; [DOI: 10.1371/journal.pmed.1003180].

43. Piscitelli P, Neglia C, Feola M, Rizzo E, Argentiero A, Ascolese M, Rivezzi M, Rao C, Miani A, Distante A, Esposito S, Iolascon G, Tarantino U. Updated incidence and costs of hip fractures in elderly Italian population. Aging Clin Exp Res. 2020; 32(12): 2587-2593. [PMID: 32056151]; [DOI: 10.1007/s40520-020-01497-0].

44. Zhang YW, Lu PP, Li YJ, Dai GC, Chen MH, Zhao YK, Cao MM, Rui YF. Prevalence, characteristics, and associated risk factors of the elderly with hip fractures: a cross-sectional analysis of NHANES 2005-2010. Clin Interv Aging. 2021; 16: 177-185. [PMID: 33542622]; [DOI: 10.2147/CIA.S291071].

45. Orimo H, Yaegashi Y, Hosoi T, Fukushima Y, Onoda T, Hashimoto T, Sakata K. Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int. 2016; 27(5): 1777-1784. [PMID: 26733376]; [DOI: 10.1007/s00198-015-3464-8].

46. Coveney EI, McKeown D, Quinlan JF, Cleary M. A healthy decline in age- and sex- specific incidence of hip fractures in the elderly in the Republic of Ireland. Surgeon. 2019 Dec 14. pii: S1479-666X(19)30147-7. [PMID: 31843381]; [DOI: 10.1016/j.surge.2019.11.006].

47. Chen FP, Shyu YC, Fu TS, Sun CC, Chao AS, Tsai TL, Huang TS. Secular trends in incidence and recurrence rates of hip fracture: a nationwide population-based study. Osteoporos Int. 2017; 28(3): 811-818. [PMID: 27832325]; [DOI: 10.1007/s00198-016-3820-3].

48. Asada M, Horii M, Ikoma K, Goto T, Okubo N, Kuriyama N, Takahashi K. Hip fractures among the elderly in Kyoto, Japan: a 10-year study. Arch Osteoporos. 2021; 16(1): 30. [PMID: 33580354]; [DOI: 10.1007/s11657-021-00888-8].

49. Swayambunathan J, Dasgupta A, Rosenberg PS, Hannan MT, Kiel DP, Bhattacharyya T. Incidence of hip fracture over 4 decades in the Framingham Heart Study. JAMA Intern Med. 2020; 180(9): 1225-1231. [DOI: 10.1001/jamainternmed.2020.2975].

50. Rey-Rodriguez MM, Vazquez-Gamez MA, Giner M, Garrachón-Vallo F, Fernández-López L, Colmenero MA, Montoya-García MJ. Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain. BMJ Open. 2020; 10(9): e037101. [PMID: 32973058]; [DOI: 10.1136/bmjopen-2020-037101].

51. Hagino H, Osaki M, Okuda R, Enokida S, Nagashima H. Recent trends in the incidence of hip fracture in Tottori Prefecture, Japan: changes over 32 years. Arch Osteoporos. 2020; 15(1): 152. [PMID: 33006016]; [DOI: 10.1007/s11657-020-00823-3].

52. Tamaki J, Fujimori K, Ikehara S, Kamiya K, Nakatoh S, Okimoto N, Ogawa S, Ishii S, Iki M; Working Group of Japan Osteoporosis Foundation. Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012-2015. Osteoporos Int. 2019; 30(5): 975-983. [PMID: 30648192]; [DOI: 10.1007/s00198-019-04844-8].

53. Takusari E, Sakata K, Hashimoto T, Fukushima Y, Nakamura T, Orimo, H. Trends in hip fracture incidence in Japan: estimates based on nationwide hip fracture surveys from 1992 to 2017. JBMR plus. 2021; 5(2): e10428.

54. Lin KB, Yang NP, Lee YH, Chan CL, Wu CH, Chen HC, Chang NT. The incidence and factors of hip fractures and subsequent morbidity in Taiwan: an 11-year population-based cohort study. PLoS One. 2018; 13(2): e0192388. [PMID: 29447190]; [DOI: 10.1371/journal.pone.0192388].

55. Ha YC, Kim TY, Lee A, Lee YK, Kim HY, Kim JH, Park CM, Jang S. Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int. 2016; 27(8): 2603-2609. [PMID: 27112763]; [DOI: 10.1007/s00198-016-3576-9].

56. Glinkowski W, Narloch J, Krasuski K, Śliwczyński A. The increase of osteoporotic hip fractures and associated one-year mortality in Poland: 2008-2015. J Clin Med. 2019; 8(9): 1487. [DOI: 10.3390/jcm8091487].

57. Nolan P, Tiedt L, Ellanti P, McCarthy T, Hogan N. Incidence of non-simultaneous contralateral second hip fractures: a single-center Irish Study. Cureus. 2020; 12(10): e11154. [DOI: 10.7759/cureus.11154].

58. Meyer AC, Ek S, Drefahl S, Ahlbom A, Hedström M, Modig K. Trends in hip fracture incidence, recurrence, and survival by education and comorbidity: a Swedish Register-based Study. Epidemiol. 2021; 32(3): 425-433. [DOI:10.1097/EDE.000000000000132]

59. Støen RO, Nordsletten L, Meyer HE, Frihagen JF, Falch JA, Lofthus CM. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. Osteoporos Int. 2012; 23(10): 2527-34. [PMID: 22246602]; [DOI: 10.1007/s00198-011-1888-3].

60. von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, Akesson K. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016; 27(10): 2945-2953. [PMID: 27172936]; [DOI: 10.1007/s00198-016-3616-5].

61. Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, Künn-Nelen A, Pettersson-Kymmer U, Eriksson S, Brenner H, Schöttker B, Saum KU, Holleczek B, Grodstein FD, Feskanich D, Orsini N, Wolk A, Bellavia A, Wilsgaard T, Jørgensen L, Boffetta P, Trichopoulos D, Trichopoulou A. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health. 2017; 2(5): e239-e246. [PMID: 29253489]; [DOI: 10.1016/S2468-2667(17)30046-4].

62. Ren Y, Hu J, Lu B, Zhou W, Tan B. Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population. Bone. 2019; 122: 143-149. [PMID: 30797059]; [DOI: 10.1016/j.bone.2019.02.020].

63. Swayambunathan J, Dasgupta A, Bhattacharyya T The pronounced impact of hip fractures on psychosocial well-being, J Am Acad Orthop Surg. 2021; 29(1): e22-e30 [DOI: 10.5435/JAAOS-D-19-00530]

64. Amrayev S, AbuJazar U, Stucinskas J, Smailys A, Tarasevicius S. Outcomes and mortality after hip fractures treated in Kazakhstan. Hip Int. 2018; 28(2): 205-209. [PMID: 29890912]; [DOI: 10.1177/1120700018773395].

65. Chen CH, Huang PJ, Huang HT, Lin SY, Wang HY, Fang TJ, Lin YC, Ho CJ, Lee TC, Lu YM, Chiu HC. Impact of orthogeriatric care, comorbidity, and complication on 1-year mortality in surgical hip fracture patients: an observational study. Medicine (Baltimore). 2019; 98(47): e17912. [PMID: 31764791]; [DOI: 10.1097/MD.0000000000017912].

66. Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019; 14(1): 203. [PMID: 31272470]; [DOI: 10.1186/s13018-019-1226-6].

67. Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed LA, Schöttker B, Brenner H, Bellavia A, Wolk A, Kubinova R, Stegeman B, Bobak M, Boffetta P, Trichopoulou A. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017; 281(3): 300-310. [PMID: 28093824]; [DOI: 10.1111/joim.12586].

68. Giummarra MJ, Ekegren CL, Gong J, Simpson P, Cameron PA, Edwards E, Gabbe BJ. Twelve month mortality rates and independent living in people aged 65 years or older after isolated hip fracture: a prospective registry-based study. Injury. 2020; 51(2): 420-428. [PMID: 31810636]; [DOI: 10.1016/j.injury.2019.11.034].

69. Guy P, Sobolev B, Sheehan KJ, Kuramoto L, Lefaivre KA. The burden of second hip fractures: provincial surgical hospitalizations over 15 years. Can J Surg. 2017; 60(2): 101-107. [PMID: 28234218]; [DOI: 10.1503/cjs.008616].

70. Chen YP, Wong PK, Tsai MJ, Chang WC, Hsieh TS, Leu TH, Jeff Lin CF, Lee CH, Kuo YJ, Lin CY. The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture. J Formos Med Assoc. 2020; 119(12): 1807-1816. [PMID: 32107098]; [DOI: 10.1016/j.jfma.2020.02.004].

71. van de Ree CLP, de Munter L, Biesbroeck BHH, Kruithof N, Gosens T, de Jongh MAC. The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: A longitudinal cohort study. Injury. 2020; 51(11): 2668-2675. [PMID: 32741607]; [DOI: 10.1016/j.injury.2020.07.049].

72. Silva DMW, Lazaretti-Castro M, Freitas Zerbini CA, Szejnfeld VL, Eis SR, Borba VZC. Incidence and excess mortality of hip fractures in a predominantly Caucasian population in the South of Brazil. Arch Osteoporos. 2019; 14(1): 47. [PMID: 30993406]; [DOI: 10.1007/s11657-019-0597-y].

73. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018; 13: 143-150. [PMID: 29416322]; [DOI: 10.2147/CIA.S150067].

74. Al-Algawy AAH, Baiee HA, Hasan S, Jassim I, Razaq M, Kamel F, Ali A, Khudhair E. Risk factors associated with hip fractures among adult people in Babylon City, Iraq. Open Access Maced J Med Sci. 2019; 7(21): 3608-3614. [PMID: 32010385]; [DOI: 10.3889/oamjms.2019.734].

75. Cauley JA, Cawthon PM, Peters KE, Cummings SR, Ensrud KE, Bauer DC, Taylor BC, Shikany JM, Hoffman AR, Lane NE, Kado DM, Stefanick ML, Orwoll ES; Osteoporotic Fractures in Men (MrOS) Study Research Group. risk factors for hip fracture in older men: the Osteoporotic Fractures in Mens Study (MrOS). J Bone Miner Res. 2016; 31(10): 1810-1819. [PMID: 26988112]; [DOI: 10.1002/jbmr.2836].

76. Feskanich D, Meyer HE, Fung TT, Bischoff-Ferrari HA, Willett WC. Milk and other dairy foods and risk of hip fracture in men and women. Osteoporos Int. 2018; 29(2): 385-396. [PMID: 29075804]; [DOI: 10.1007/s00198-017-4285-8].

77. Khadgawat R, Brar KS, Gahlot M, Yadav CS, Malhotra R, Gupta N, Tandon N. High prevalence of vitamin D deficiency in Asian-Indian patients with fragility hip fracture: a pilot study. J Assoc Physicians India. 2010; 58: 539-542. [PMID: 21391372]

78. Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018; 19(1): 369. [PMID: 30314495]; [DOI: 10.1186/s12891-018-2276-3].

79. Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med (Lond). 2020; 81(8): 1-10. [PMID: 32845763]; [DOI: 10.12968/hmed.2020.0215].

80. Chen FP, Fu TS, Lin YC, Fan CM. Risk factors and quality of life for the occurrence of hip fracture in postmenopausal women. Biomed J. 2018 Jun; 41(3): 202-208. [DOI: 10.1016/j.bj.2018.04.001]; [PMID: 30080660]

81. Avenell A, Mak JC, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014 Apr 14;2014(4):CD000227. [DOI: 10.1002/14651858.CD000227.pub4]; [PMID: 24729336]; [PMCID: PMC7032685].

82. Chutterpaul, P, Paruk, F, Cassim, B. Prevalence of vitamin D deficiency in older South Africans with and without hip fractures and the effects of age, body weight, ethnicity and functional status J Endocrinol Metab Diab S Afr 2019; 24(1): 10-15.

83. Dadra A, Aggarwal S, Kumar P, Kumar V, Dibar DP, Bhadada SK. High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: a pilot study. J Clin Orthop Trauma. 2019 Nov-Dec; 10(6): 1097-1100. [DOI: 10.1016/j.jcot.2019.03.012]; [PMID:31708635]

84. Dretakis K, Igoumenou VG. The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type. Aging Clin Exp Res. 2019: 31: 1501-1507. [DOI: 10.1007/s40520-019-01132-7]

85. Han J, Cho Y, Jee S, Jo S. Vitamin D levels in patients with low-energy hip fractures. Hip Pelvis. 2020; 32(4): 192-198. [DOI: .5371/hp.2020.32.4.192]

86. Jamal AB, Hasan Khan MN, Sadiq M. Intertrochanteric Hip fractures and vitamin D deficiency; a significant association. J Ayub Med Coll Abbottabad. 2021; 33(2): 257-261. [PMID: 34137541].

87. Niikura T, Oe K, Sakai Y, Iwakura T, Fukui T, Nishimoto H, Hayashi S, Matsumoto T, Matsushita T, Maruo A, Yagata Y, Kishimoto K, Sakurai A, Kuroda R. Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population. J Orthop Surg (Hong Kong). 2019; 27(3): 2309499019877517. [PMID: 31554468]; [DOI: 10.1177/2309499019877517].

88. Yao P, Bennett D, Mafham M, Lin X, Chen Z, Armitage J, Clarke R. Vitamin D and calcium for the prevention of fracture: a systematic review and meta-analysis. JAMA Netw Open. 2019; 2(12): e1917789. [PMID: 31860103]; [DOI: 10.1001/jamanetworkopen.2019.17789].

89. Lai JK, Lucas RM, Clement MS, Roddam AW, Banks E. Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies. BMC Public Health. 2010; 10(1): 1-17.

90. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2014; 383(9912): 146-55. [PMID: 24119980] [DOI: 10.1016/S0140-6736(13)61647-5]

91. Poole CD, Smith JC, Davies JS. The short-term impact of vitamin D-based hip fracture prevention in older adults in the United Kingdom. J Endocrinol Invest. 2014; 37(9): 811-7. [PMID: 24957166]; [DOI: 10.1007/s40618-014-0109-2].

92. Sim DS, Tay K, Howe TS, Koh SBJ. Preoperative severe vitamin D deficiency is a significant independent risk factor for poorer functional outcome and quality of life 6 months after surgery for fragility hip fractures. Osteoporos Int. 2021 May 7. [PMID: 33959793]. [DOI: 10.1007/s00198-021-05970-y].

93. Thorpe DL, Beeson WL, Knutsen R, Fraser GE, Knutsen SF. Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans. Am J Clin Nutr. 2021 May 8: nqab095. [PMID: 33964850]; [DOI: 10.1093/ajcn/nqab095].

94. Wang N, Chen Y, Ji J, Chang J, Yu S, Yu B. The relationship between serum vitamin D and fracture risk in the elderly: a meta-analysis. J Orthop Surg Res. 2020; 15(1): 81. [DOI:10.1186/s13018-020-01603-y]

95. Whiting SJ, Li W, Singh N, Quail J, Dust W, Hadjistavropoulos T, Thorpe LU. Predictors of hip fractures and mortality in long-term care homes in Saskatchewan: Does vitamin D supplementation play a role? J Steroid Biochem Mol Biol. 2020; 200: 105654. [PMID: 32169586]; [DOI: 10.1016/j.jsbmb.2020.105654].

96. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016; 27(1): 367-376. [PMID: 26510847]

97. Zhao J, Cai Q, Jiang D, Wang L, Chen S, Jia W. The Associations of serum vitamin D and bone turnover markers with the type and severity of hip fractures in older women. Clin Interv Aging. 2020; 15: 1971-1978. [PMID: 33116451]; [DOI: 10.2147/CIA.S271904].

98. Zhang S, Miller DD, Li W. Non-musculoskeletal benefits of vitamin D beyond the musculoskeletal system. Int J Mol Sci. 2021; 22(4): 2128. [PMID: 33669918]; [DOI: 10.3390/ijms22042128]

99. Zhao JG, Zeng XT, Wang J, Liu L. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA. 2017; 318(24): 2466-2482. [PMID: 29279934]; [DOI: 10.1001/jama.2017.19344].

100. Steingrimsdottir L, Halldorsson TI, Siggeirsdottir K, Cotch MF, Einarsdottir BO, Eiriksdottir G, Sigurdsson S, Launer LJ, Harris TB, Gudnason V, Sigurdsson G. Hip fractures and bone mineral density in the elderly--importance of serum 25-hydroxyvitamin D. PLoS One. 2014; 9(3): e91122. [PMID: 24621578]; [DOI: 10.1371/journal.pone.0091122].

101. Yu SJ, Yang Y, Zang JC, Li C, Wang YM, Wang JB. Evaluation of serum 25-hydroxyvitamin D3 and bone mineral density in 268 patients with hip fractures. Orthop Surg. 2021; 13(3): 892-899. [DOI:10.1111/os.12920]

102. Neale RE, Wilson LF, Black LJ, Waterhouse M, Lucas RM, Gordon LG. Hospitalisations for falls and hip fractures attributable to vitamin D deficiency in older Australians. Br J Nutr. 2021 29: 1-5. [PMID: 33509323]; [DOI: 10.1017/S0007114521000416].

103. Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, Clarke BL, Cody KM, Cooper C, Crandall CJ, Dirschl DR, Eagen TJ, Elderkin AL, Fujita M, Greenspan SL, Halbout P, Hochberg MC, Javaid M, Jeray KJ, Kearns AE, King T, Koinis TF, Koontz JS, Kužma M, Lindsey C, Lorentzon M, Lyritis GP, Michaud LB, Miciano A, Morin SN, Mujahid N, Napoli N, Olenginski TP, Puzas JE, Rizou S, Rosen CJ, Saag K, Thompson E, Tosi LL, Tracer H, Khosla S, Kiel DP. Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition. J Bone Miner Res. 2020; 35(1): 36-52. [PMID: 31538675]; [DOI: 10.1002/jbmr.3877].

104. Salamon A, Toldy E, Biró C, Mátrai Á, Balassa T, Lőcsei Z. Vitamin D and calcium supplementation in elderly patients with hip fracture]. Orv Hetil. 2017; 158(43): 1699-1707. Hungarian. [PMID: 29135297]; [DOI: 10.1556/650.2017.30857].

105. Dhanwal DK, Sahoo S, Gautam VK, Saha R. Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism. Osteoporos Int. 2013 Feb; 24(2): 553-7. [PMID: 22543576]; [DOI: 10.1007/s00198-012-1993-y].

106. Zhao J, Cai Q, Jiang D, Wang L, Chen S, Jia W. The associations of serum vitamin d and bone turnover markers with the type and severity of hip fractures in older women. clin interv aging. Clin Interv Aging. 2020; 15: 1971-1978. [PMID: 33116451]; [DOI:10.2147/CIA.S271904].

107. Ingstad F, Solberg LB, Nordsletten L, Thorsby PM, Hestnes I, Frihagen F. Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporos Int. 2021; 32(5): 873-881. [PMID: 33201249]. [DOI: 10.1007/s00198-020-05739-9].

108. Hao L, Carson JL, Schlussel Y, Noveck H, Shapses SA. Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study. Am J Clin Nutr. 2020; 112(3): 613-618. [PMID: 32073599]; [DOI: 10.1093/ajcn/nqaa029].

109. Jarusriwanna A, Phusunti S, Chotiyarnwong P, Unnanuntana A. High-dose versus low-dose ergocalciferol for correcting hypovitaminosis D after fragility hip fracture: a randomized controlled trial. BMC Geriatr. 2021; 21(1): 72. [PMID: 33478397]; [DOI: 10.1186/s12877-021-02023-1].

110. Mak JC, Mason RS, Klein L, Cameron ID. An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial. BMC Musculoskelet Disord. 2016; 17: 336. [PMID: 27515154]; [DOI: 10.1186/s12891-016-1174-9].

111. Sprague S, Slobogean GP, Bogoch E, Petrisor B, Garibaldi A, O’Hara N, Bhandari M; FAITH Investigators. Vitamin D use and health outcomes after surgery for hip fracture. Orthopedics. 2017; 40(5): e868-e875. [PMID: 29039872]; [DOI: 10.3928/01477447-20170907-01].

112. Laiz A, Malouf J, Marin A, Longobardi V, de Caso J, Farrerons J, Casademont J. Impact of 3-Monthly Vitamin D supplementation plus exercise on survival after surgery for osteoporotic hip fracture in adult patients over 50 years: a pragmatic randomized, partially blinded, controlled trial. J Nutr Health Aging. 2017; 21(4): 413-420. [PMID: 28346568]; [DOI: 10.1007/s12603-016-0773-3].

113. Orces CH, Gavilanez EL. Increasing hip fracture rates among older adults in Ecuador: analysis of the National Hospital Discharge System, 1999-2016. Arch Osteoporos. 2017; 12(1): 109. [PMID: 2921865]; [DOI: 10.1007/s11657-017-0410-8].

114. Chevalley T, Brandi ML, Cavalier E, Harvey NC, Iolascon G, Cooper C, Hannouche D, Kaux JF, Kurth A, Maggi S, Maier G, Papavasiliou K, Al-Daghri N, Sosa-Henríquez M, Suhm N, Tarantino U, Reginster JY, Rizzoli R. How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture? Osteoporos Int. 2021: 20: 1-15. [PMID: 34013461]; [DOI: 10.1007/s00198-021-05957-9].

115. Bischoff-Ferrari HA. Vitamin D in geriatric patients..Internist (Berl). 2020; 61(6): 535-540. German. [PMID: 32458373]; [DOI: 10.1007/s00108-020-00803-2].

116. Wu H, Pang Q. The effect of vitamin D and calcium supplementation on falls in older adults : a systematic review and meta-analysis. Orthopade. 2017; 46(9): 729-736. [PMID: 28718008]; [DOI: 10.1007/s00132-017-3446-y].

117. Gil Á, Plaza-Diaz J, Mesa MD. Vitamin D: classic and novel actions. Ann Nutr Metab. 2018; 72(2): 87-95. [PMID: 29346788]; [DOI: 10.1159/000486536].

118. Nguyen MH, Lui SK. Holistic management of older patients with hip fractures. Orthop Nurs. 2020; 39(3): 183-191. [PMID: 32443094]. [DOI.1097/NOR.0000000000000656].

119. Di Monaco M, Castiglioni C, Di Carlo S, La Marmora E, Filipovic I, Milano E, Minetto MA, Massazza G. Classes of vitamin D status and functional outcome after hip fracture: a prospective, short-term study of 1350 inpatients. Eur J Phys Rehabil Med. 2019; 55(1): 56-62. [PMID: 29904045]. [DOI: 10.23736/S1973-9087.18.05191-2].

120. Ho AWH, Wong SH. Second hip fracture in Hong Kong - Incidence, demographics, and mortality. Osteoporos Sarcopenia. 2020; 6(2): 71-74. [PMID: 32715097]; [DOI: 10.1016/j.afos.2020.05.004].

121. Ramírez-Martín R, Castell Alcalá MV, Alarcón T, Queipo R, Ríos Germán PP, Otero Puime Á, González-Montalvo JI. Comprehensive geriatric assessment for identifying older people at risk of hip fracture: cross-sectional study with comparative group. Fam Pract. 2017; 34(6): 679-684. [PMID: 29106548].[DOI: 10.1093/fampra/cmx059].

122. Hwang JS, Tsai KS, Cheng YM, Chen WJ, Tu ST, Lu KH, Hou SM, Yang SH, Cheng H, Lai HJ, Lei S, Chen JF. Vitamin D status in non-supplemented postmenopausal Taiwanese women with osteoporosis and fragility fracture. BMC Musculoskelet Disord. 2014 Jul 28; 15: 257. [PMID: 25069806]; [DOI: 10.1186/1471-2474-15-257].


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.