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A Randomized Controlled Trial

Heike A. Bischoff-Ferrari, MD, DrPH; Bess Dawson-Hughes, MD; Andreas Platz, MD; Endel J. Orav, PhD; Hannes B. Stähelin, MD; Walter C. Willett, MD, DrPH; Uenal Can, MD; Andreas Egli, MD; Nicolas J. Mueller, MD; Silvan Looser, PT; Beat Bretscher, PT; Elisabeth Minder, MD; Athanasios Vergopoulos, MD; Robert Theiler, MD

Arch Intern Med. 2010;170(9):813-820.

Background  Care of elderly patients after hip fracture is not well established.

Methods  We enrolled 173 patients with acute hip fracture who were 65 years or older (79.2% women; mean age, 84 years; 77.4% living at home). Using a factorial design, we randomly allocated patients to extended physiotherapy (PT) (supervised 60 min/d during acute care plus an unsupervised home program) vs standard PT (supervised 30 min/d during acute care plus no home program; single-blinded), and to cholecalciferol therapy, 2000 vs 800 IU/d (double-blinded). Primary outcome was rate of falls; secondary outcome was rate of hospital readmissions during the 12-month follow-up. All analyses included 173 individuals and used multivariate Poisson regression analyses.

Results  At baseline, 50.9% of participants had 25-hydroxyvitamin D levels of less than 12 ng/mL and 97.7% of less than 30 ng/mL. We documented 212 falls and 74 hospital readmissions. Because this was a factorial design trial, all analyses tested the main effect of each treatment while controlling for the other in 173 participants. Extended vs standard PT reduced the rate of falls by 25% (95% confidence interval [CI], –44% to –1%). Cholecalciferol treatment, 2000 vs 800 IU/d, did not reduce falls (28%; 95% CI, –4% to 68%), but reduced the rate of hospital readmissions by 39% (95% CI, –62% to –1%).

Conclusions  Extended PT was successful in reducing falls but not hospital readmissions, whereas cholecalciferol treatment, 2000 IU/d, was successful in reducing hospital readmission but not falls. Thus, the 2 strategies may be useful together because they address 2 different and important complications after hip fracture.

Trial Registration  clinicaltrials.gov identifier: NCT00133640

Author Affiliations: Centre on Aging and Mobility, University of Zurich (Drs Bischoff-Ferrari and Egli and Mr Looser), Department of Rheumatology and Institute of Physical Medicine (Dr Bischoff-Ferrari), Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine (Dr Mueller), and Institute for Clinical Chemistry (Dr Vergopoulos), University Hospital Zurich, and Departments of Traumatology (Drs Platz and Can), Rheumatology (Messrs Looser and Bretscher and Dr Theiler), and Laboratory Medicine (Dr Minder), Triemli City Hospital, Zurich, Switzerland; Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University (Dr Dawson-Hughes), and Departments of Biostatistics (Dr Orav) and Nutrition (Dr Willett), Harvard School of Public Health, Boston, Massachusetts; and Department of Geriatrics, University of Basel, Basel, Switzerland (Dr Stähelin).

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