Ricerc@Sapienza

Introduction: Vitamin D is a fat-soluble hormone with
pleiotropic effects, whose deficiency in the elderly
contributes to the development of osteoporosis
and sarcopenia, increasing the risk of fractures, falls
and consequent morbidity and mortality. Studies
show a very low level of vitamin D in patients with
hip fractures but it has never been shown whether
there is an influence of inflammatory stress linked
to surgery in reducing these levels or whether it is
linked only to pre-fracture conditions.
The aim of the study was to compare the circulating
levels of 25-hydroxycholecalciferol, in the preand post-operative stages and to find a relation
between the reduction of vitamin D levels and
the inflammation markers in patients undergoing
surgery for hip fracture.
Methods: We recruit hip fracture patients aged
over 65. Were excluded from the study: inoperable
patients, those with secondary fractures to
neoplastic diseases, subjects suffering from severe
renal and hepatic impairment, those with known
infections and bone metabolism diseases (primary
hyperparathyroidism, Paget) and those undergoing
systemic chronic corticosteroid therapy.
Blood tests were performed for each patient at
time zero (T0) and on the second post-operative
day (T48), with the following parameters: blood
count with formula, vitamin D (VIT D), PTH, PCR,
albumin, D- Dimer, fibrinogen, ferritin, calcemia and
creatinine. For each parameter have been evaluated:
the variations, the significance of these and the
possible correlations between them.
Results: Our sample is made up of 50 patients: 41
females and 9 males, mean age:82.25 ± 8.11 years.
The analysis of the blood tests carried out at time 0
and on the second post-operative day (T48) shows a
statistically significant reduction (p <0.001) of postoperative VIT D values (11.37 ng / ml vs 9 , 4 ng / ml).
Finally, the evaluation of the relationship between
VIT D and inflammation markers, measured
respectively at T0 and T48, shows only an inverse
correlation between VIT D levels and PCR (p = 0.044,
r = - 0,289) which significantly increase (p <0.001) in
the post-operative period (5.45 mg / dl vs 14 mg / dl).
Conclusion: In literature there is evidence of a link
between VIT D levels and systemic inflammatory
level, typical of subjects suffering from fragility
fractures and surgically treated, probably due to
the utilization of vitamin D storage during the antiinflammatory reaction.
Our pilot study shows that the VIT D values, already
deficient in most of our elderly patients, are further
reduced after surgery. The relation with PCR could be
explained by the evidence of a genetic link between
vitamin D and PCR; in fact some polymorphisms
(SNP) in the PCR gene predispose to a phenotype
with high PCR values and reduced vitamin values.
By the importance of Vitamin D in the postfracture and the high perioperative inflammatory
level of elderly patients with hip fractures, a
supplementation of VIT D should be prescribed.