Endocrine Abstracts

Background

Vitamin D and calcium deficiencies is of particular importance in older patients undergoing medical rehabilitation and having a high risk of fractures. Preventing falls and fractures, including during the course of rehabilitation, is an important challenge that can be addressed in these patients, in particular through improved nutrition and vitamin D and calcium supplementation.

Objectives

To evaluate the effect of long-term calcium and vitamin D3 intake on calcium homeostasis and fall’s rate in patients with high fracture risk starting rehabilitation course.

Methods

The study enrolled 119 men and women aged 50–80 y.o. with high absolute fracture probability by FRAX who started medical rehabilitation. 41 patients have been receiving antiresorptive therapy already comprised group 1, other patients were randomized into groups 2 (n = 39) and 3 (control, n = 39). In groups 1 and 2, a food supplement containing calcium citrate 1000 mg and vitamin D3 600 IU was prescribed for 12 months. All patients undergo laboratory examination, food calcium intake and fall assessment at baseline, in 6 and 12 months

Results

Daily calcium intake in the study sample (n = 119) was 782.9 ± 243.4 mg. Vitamin D deficiency was detected in 38.4% of the examined. An increase in 25(OH)D level was noted in groups 1 and 2 after 6 and 12 months (P < 0.01). Patients in group 1 showed an increase in serum osteocalcin and calcium levels after 6 and 12 months (P < 0.05). In group 3, there was an increase of immunoreactive parathyroid hormone levels after 6 (P < 0.05) and 12 months (P < 0.01), C-terminal telopeptide of type I collagen level and alkaline phosphatase activity after 12 months (P < 0.05). In group 1, there was also a decrease in proportion of patients who fell after 6 months (χ² = 4.97, P = 0.026) and a decrease in the total number of falls after 12 months (χ² = 4.89, P = 0.027). Group 2 showed a decrease in the number of patients who fell after 6 and 12 months (χ² = 48.58, P = 0.0034 at both stages of the study) and the number of falls in general after 6 months (χ² = 6.02, P = 0.0142).

Conclusion

The obtained data allow us to recommend prescription of dietary supplements containing calcium and vitamin D3 as a part of complex rehabilitation of patients with high fracture risk.