Aim: To evaluate whether the rate inpatient antiresorptive medication administration increased following the implementation of a new protocol, where high-dose (50,000 units) oral colecalciferol was administered daily for up to six days upon admission, for patients aged ≥50 with a neck of femur fracture.
Methods: A retrospective single-centre cohort study was conducted using data from the Wagga Wagga Base Hospital Australian and New Zealand Hip Fracture Registry and Electronic Medical Records. The intervention group comprised of 216 consecutive admissions, following new protocol implementation in February 2023. The control group consisted of 216 consecutive admissions prior to October 2022, who received standard care.
Results: Vitamin D deficiency was identified in 81 patients (37.5%) in the intervention group and 101 patients (46.8%) in the control group. Among vitamin D deficient patients in the intervention group, 72 (90.1%) received high-dose oral colecalciferol. Inpatient antiresorptive medication was administered to 161 patients (71.6%) in the intervention group, vs 68 patients (31.9%) in the control group (OR 2.52, p<0.01). Inpatient complications of hypocalcaemia and hypophosphataemia were more frequent in the intervention group (14.4% vs 5.6%, p<0.01). At one year, vitamin D deficient patients in the intervention group had lower rates of neck of femur fracture recurrence (3.7% vs 6.9%) and mortality (23.5% vs 27.7%).
Conclusions: The high-dose oral colecalciferol protocol in admitted neck of femur fracture patients increased the inpatient rate of antiresorptive medication administration, with manageable electrolyte disturbances and reduced one-year neck of femur fracture recurrence and mortality.