25-Hydroxyvitamin D Levels, Free Serum Calcium, Glomerular Filtration Rate, Albumin, and Femoral Fracture Elderly Patient Mortality

Abstract

INTRODUCTION: Proximal femoral fractures (PFFs) in older adults carry a high risk of morbidity, mortality, and disability. Although vitamin D deficiency has been associated with increased fracture incidence and poor outcomes, its precise role in hospitalization length, mortality, and long-term recovery remains unclear. Understanding how vitamin D levels interact with other factors, such as renal function and albumin status, could improve patient management strategies. METHODS: We conducted a prospective cohort study of 760 patients aged 65 years and older admitted with femoral fractures between November 2022 and October 2024. Serum 25(OH)D levels, corrected calcium, and glomerular filtration rate (GFR) were assessed at admission. Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20 to 30 ng/mL), or normal (>30 ng/mL). Albumin levels and GFR were also evaluated. RESULTS: When analyzed categorically, vitamin D classification did not markedly predict short-term outcomes, including immediate postoperative mortality or length of hospital stay. However, vitamin D as a continuous variable was modestly associated with shorter hospital stays. By contrast, lower GFR was strongly linked to longer hospitalization and increased in-hospital mortality. Albumin levels were not markedly related to survival. Notably, over a 2-year follow-up, vitamin D status emerged as an important predictor of long-term survival. CONCLUSION: Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after PFF surgery. Addressing renal impairment and other patient-specific factors remains critical for optimizing outcomes.