ASSOCIATION OF BIOCHEMICAL MARKERS WITH SEVERITY OF HIP FRAGILITY FRACTURES

Abstract

Background:

In elderly individuals, fragility fractures occur due to significantly reduced bone strength caused by changes in bone mass, architecture, and material properties. These fractures typically result from low-energy injuries and are associated with vitamin D insufficiency as an independent risk factor. Vitamin D deficiency is also linked to poor muscle function, muscle weakness, increased fall risk, inadequate post-injury rehabilitation, and a higher likelihood of refracture. Understanding the relationship between vitamin D, serum calcium, and hip fracture severity can aid in developing personalized prevention strategies, improving prognosis, optimizing treatment plans, and delivering tailored therapeutic approaches.There have been no studies to see for an association of serum calcium and vitamin D with the severity of fragility hip fractures. Our study aims to analyze the baseline differences of calcium and vitamin D levels in patients with different types of hip fractures and their severity. Objectives: a) To determine the serum calcium levels and serum Vitamin-D levels in elderly patients having fragility hip fractures at Saveetha Medical College ,  Thandalam, Chennai,TamilNadu, India . b) To categorize hip fractures based on their type and further subclassify them based on their severity. c) To correlate the calcium and Vitamin-D and  levels in elderly patients with severity of fractures of hip which are further classified based on age and gender.

Materials and Methods: A hospital-based descriptive prospective study was conducted among elderly patients (over 50 years of age) who presented with fragility fractures of the hip joint at the Emergency Trauma Care Center and OPD of the Orthopaedic Department at Saveetha Medical College ,  Thandalam, Chennai,TamilNadu, India. The study period was from october1, 2022, to october1, 2023. A total of 30 patients were included in the study. The patient's biographical information, injury date, and fracture type were recorded. The levels of serum calcium and vitamin D were measured and reported upon admission. Data Management: Version 23 of the Statistical Package for the Social Sciences (SPSS) was used to input, code, and analyze the data. The main findings were the levels of calcium and 25-hydroxycholecalciferol in the serum. The distribution of 25-hydroxycholecalciferol and calcium was summarized using means with standard deviations and the median with interquartile range (IQR). The Kruskal-Wallis and Mann-Whitney tests were conducted to determine if serum calcium and vitamin D levels correlated with specific patient features. The association between serum calcium and vitamin D levels and gender groups, different types of fractures, and the severity of fractures was examined using the chi-square test. Results: Out of 30 enrolled patients for the study, 37.5% were of the age group 60-69 years, with a male predominance of 63.3%. More men had deficient vitamin D levels than women. 

Keywords: Neck of femur fracture, Intertrochanteric femur fracture, Sub trochanteric femur fracture.

 Result: 53.3% of the participants in the research showed vitamin D insufficiency. Only 6% of people had normal blood vitamin D levels, while 6% were vitamin D deficient. For 13.3% of the research subjects, the albumin-adjusted calcium levels were normal, but for 11% of them, calcium levels were low. The most common type of hip fracture was neck of femur fracture at 43.3%, followed by Intertrochanteric fracture at 50%, and subtrochanteric femur fracture at 6.66%. Among Intertrochanteric femur fractures, 6.6% belonged to Boyd and Griffin type 4 and 10% belonged to type 1. Among neck of femur fractures, 10% belonged to Garden's type 4 and 23.3% belonged to type 1. Among subtrochanteric femur fractures, 6.6% belonged to Russell-Taylor's type 1 . Thus, the maximum percentage of patients with different hip fractures presented to us belonged to the more severe type of their respective fractures. There was a statistically significant difference seen for the intertrochanteric femur fracture, neck of femur fracture, and subtrochanteric femur fracture for the varying levels of serum calcium and vitamin D. 38.4% of intertrochanteric femur fracture and 33.3% of neck of femur fracture patients had hypocalcemia. 23% of intertrochanteric femur fracture and 20% of neck of femur fracture had vitamin D deficiency. There was a significant association of serum calcium and vitamin D levels with the severity of hip fractures. Among intertrochanteric femur fractures, all type 4 fractures had hypocalcemia (100%) and vitamin D insufficiency (100%). Among neck of femur fractures, almost all type 4 fractures had hypocalcemia (100%) and vitamin D deficiency (100%).

Conclusion:  We concluded that the prevalence of vitamin D deficiency and insufficiency, as well as hypocalcemia, was high in this study. This was especially true when evaluated among different types of hip fractures and their severity. We could conclude that the more deficient the serum calcium levels and the more deficient/insufficient the serum vitamin D levels, the more severe the type of fracture. A weak statistically significant association was found between serum calcium and vitamin D levels with age and sex.