1726 Vitamin D single dose loading regimen in neck of femur fracture patients

Abstract

Abstract Introduction The best practice tariff for Neck of Femur Fractures (NOFF) was designed to improve patient outcomes and includes establishing and implementing a bone protection plan (BPP). Optimal management is often delayed due to insufficient vitamin D levels. Here we reviewed the administration of anti-resorptive therapies (AR) when giving vitamin D loading doses over 7 weeks compared to stat high dosing followed by maintenance therapy. Method Pre-intervention, we reviewed vitamin D levels, the treatment given and the bone protection therapy administered in all new NOFF admissions over 3 months. We introduced once only high dose vitamin D therapy in vitamin D deplete individuals over the subsequent 3 months; deplete (Vit D <50) patients received 140,000 units stat colecalciferol and adcal maintenance, patients with insufficient levels (Vit D 50-70) received 60,000 units stat colecalciferol and adcal maintenance and replete individuals received adcal maintenance. Patients were then given in-patient AR therapy or referred to fracture liaison service (FLS) for further BPP assessment. Results Pre-intervention included 64 patients, of which 61% (N=39) had low vitamin D levels (deplete and insufficient combined). These patients were loaded with once weekly 40,000 units of vitamin D for 7 weeks and referred to FLS, with 51% (N=24) receiving an appointment within 4 months. Only 14% (N=9) received in-patient AR treatment. Post intervention, 84 patients were reviewed. Vitamin D replacement was required in 69% (N=59) of patients, of which 83% (N=49) received loading regimen as per protocol. This allowed 53% (N=20) of eligible patients to receive in-patient AR therapy with 43% (N=11) of those not receiving therapy being impacted by junior doctor strikes. Conclusion Administrating high dose vitamin D to NOFF patients allowed us to increase in-patient AR therapy treatment 3.7 times. This simple intervention results in less out-patient appointments and treatment is given before an opportunity to re-fracture.