Endocrine Abstracts

In elderly subjects the mortality rate after hip fractures ranges from 18 to 33% within one year; among survivors, 40% did not return to the previous level of functional ability. The aim of this study was to evaluate the longitudinal changes of some markers of bone metabolism in relation to functional and nutritional status.

Thirthy-seven subjects aged more 70y with a new vertebral or hip fracture were admitted to the study. Thirthy age-matched and not fracured subjects hospitalized for rehabilitation purpose were considered as controls. Fractured subjects were treated with biphosphonate, calcium and vitamin D, while kinesic therapy was performed in both groups. All subjects underwent cognitive, functional and nutritional assessment and biochemical evaluation (nutritional and bone metabolism parameters). Bone mineral density was measured by calcaneal quantitative ultrasonography.

All measures were repeated 3, 6 and 12 months later.

A very high percentage of osteoporosis and of vitamin D deficiency was detected in both groups (more than 80%). Serum levels of BAP and NTX were higher in fractured subjects than in control group and showed a significant trend towards the recovery in the later phase of follow up (from 6 to 12 months).

In fractured patients the Mini Nutritional Assessment was indicative of malnutrition, but showed a significant improvement during follow up. Both T score and serum vitamin D levels were significantly linked to nutritional status, mood and functional abilities.

Vitamin D deficiency seems to be one of the most important factors involved in osteoporotic fractures. A reduction in functional abilities may play an additive role.

Even in very old subjects treatment with biphosphonates and calcium and vitamin D supplementation allow a successful osteoporotic fracture recovery.