Comparing the Effectiveness of Oral versus Intramuscular Vitamin D Supplementation in Adults with Fracture around Hip and Vitamin D Deficiency

Abstract

Introduction: Cholecalciferol plays vital role in bone mineralization. Major circulating and storage form of vitamin D is 25-hydroxycholecalciferol {25(OH)D3} which is formed in the liver after 25-hydroxylation. It is also the form of vitamin D that is measured in blood tests to detect deficiency of vitamin D. There is scarcity of literature to support the best therapy at the lowest effective dose that is practicable, cost efficient, and devoid of probable side effects. Oral medication compliance is a major stumbling block to replenishing vitamin D levels in the body. Vitamin D administered intramuscularly (i.m.) may be able to overcome this limitation. Aim: To compare the effectiveness of oral versus intramuscular vitamin D in adults with fracture around hip and vitamin D deficiency. Materials and Methods: This prospective interventional study was conducted in Orthopaedics Ward in Mahatma Gandhi Institute of Medical Sciences, Jaipur, Rajasthan, India, from January 2020 to June 2021. Total 60 male and female, above 18 years, with fractures around the hip and vitamin D levels less 30 ng/mL were included in the study. In group O (n=30) patient received oral vitamin D supplementation of 60000 IU once a week for 6 weeks . In group I (n=30) patient received single dose of 600000 IU vitamin D injection (i.m.). Follow-up of patients was done at baseline, 6 weeks and 12 weeeks for serum values of vitamin D, calcium, alkaline phosphatase and parathyroid hormone levels. Bivariate analytical techniques has been used to measure the improvement of group I with group O. Results: The mean age in group I was 60.40±16.38 years and in group O was 59.47±15.17 years (p-value=0.82). There were total 31 females, 13 in group I and 18 in group O. No significant difference was observed among the groups in vitamin D level at the baseline, {group I: 13.84 ± 3.54 ng/mL; group O: 16.45 ± 6.3 ng/mL, p-value=0.053}. At 6 weeks, the mean value of the vitamin D significantly increased in both groups (p-value=0.001; group I: 40.94±4.67 ng/mL and group O: 33.64±9.89 ng/mL). At the 12th week, the mean value of the vitamin D was significantly higher in group I (44.52±7.09 ng/mL) compared to group O (24.65±10.92 ng/mL), p-value<0.001. The vitamin D mean was significantly raised with the time in group I and group O at 6 weeks and still remained increased at 12 weeks in group I but not in group O. Conclusion: The present study concluded that although both administration routes are effective and appear to be safe, intramuscular application is more effective in increasing 25(OH) D levels and sustaining it for a longer period of time as compared to oral dose.