THE IMPACT OF VITAMIN D3 LEVELS ON RECOVERY AND REHABILITATION FOLLOWING SURGICAL TREATMENT OF FEMORAL NECK FRACTURES: A NARRATIVE REVIEW
Abstract
Introduction and purpose: Femoral neck fractures are a major source of morbidity and mortality among older adults, frequently leading to prolonged hospitalization, disability, and loss of independence. Vitamin D3 plays a central role in bone metabolism, muscle function, and immune modulation- all crucial for postoperative recovery. However, the clinical relevance of vitamin D3 status in patients undergoing surgery for femoral neck fractures remains incompletely understood. This narrative review aims to synthesize current evidence on the relationship between vitamin D3 levels and key outcomes including functional recovery, complication rates, and mortality in this population.
Material and method: A comprehensive literature search was conducted in PubMed and Embase using Boolean operators and relevant medical subject terms. Filters limited the search to full-text, English-language studies published between 2020 and 2025 involving human subjects. In Embase, only randomized controlled trials and systematic reviews were included. A total of 98 non-duplicate studies were screened; 34 were selected for full-text analysis and thematic synthesis.
Results: Most studies demonstrate a positive association between sufficient 25(OH)D levels and faster mobility recovery, improved functional scores (e.g., Harris Hip Score, Barthel Index), and better postoperative quality of life. Vitamin D3 deficiency is consistently linked to higher rates of infectious complications, delayed fracture healing, and increased fall risk. Several studies also associate low 25(OH)D levels with elevated short-term mortality. Supplementation strategies appear beneficial, although optimal dosing and timing remain under debate.
Conclusions: Vitamin D3 status is a potentially modifiable factor influencing outcomes after femoral neck fracture surgery. Routine screening and appropriate supplementation should be considered as part of multidisciplinary perioperative care. Further randomized trials are needed to define causal relationships and refine clinical protocols.
References
Arima K, Mizukami S, Nishimura T, et al. Epidemiology of the association between serum 25-hydroxyvitamin D levels and musculoskeletal conditions among elderly individuals: a literature review. J Physiol Anthropol. 2020;39(1). doi:10.1186/s40101-020-00249-3
Chevalley T, Brandi ML, Cavalier E, et al. How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture? Osteoporosis International. 2021;32(10):1921-1935. doi:10.1007/s00198-021-05957-9
Zhu K, Zhang J, Zhang C, et al. Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture. Osteoporosis International. 2021;32(3):559-564. doi:10.1007/s00198-020-05637-0
Roy D, Pande S, Thalanki S, et al. Hip fractures in elderly patients with non-dialysis dependent chronic kidney disease Outcomes in a Southeast Asian population. Medicine (United States). 2021;100(27):E26625. doi:10.1097/MD.0000000000026625
Nurmi-Lüthje I, Tiihonen R, Paattiniemi EL, et al. Relatively low and moderate pre-fracture serum 25-hydroxyvitamin D levels associated with the highest survival in elderly hip fracture patients in Finland: a minimum 3-year follow-up. Osteoporosis International. 2022;33(3):611-621. doi:10.1007/s00198-021-06094-z
Jamal AB, Hasan Khan MN, Sadiq M. Intertrochanteric Hip Fractures And Vitamin D Deficiency; A Significant Association. J Ayub Med Coll Abbottabad. 2021;33(2):257-261.
Dauny V, Thietart S, Cohen-Bittan J, et al. Association between Vitamin D Deficiency and Prognosis after Hip Fracture Surgery in Older Patients in a Dedicated Orthogeriatric Care Pathway. Journal of Nutrition, Health and Aging. 2022;26(4):324-331. doi:10.1007/s12603-022-1762-3
Fu G, Wu R, Zhang R, et al. Preoperative Vitamin D Deficiency is Associated with Increased One-Year Mortality in Chinese Geriatric Hip Fracture Patients – A Propensity Score Matching Study. Clin Interv Aging. 2023;18:263-272. doi:10.2147/CIA.S395228
Chiang MH, Kuo YJ, Chang WC, et al. Association of vitamin d deficiency with low serum albumin in taiwanese older adults with hip fracture: A prospective cross-sectional study. J Nutr Sci Vitaminol (Tokyo). 2021;67(3):153-162. doi:10.3177/jnsv.67.153
Guerra MTE, Wagner M, Vargas A, Galia CR. Low serum levels of vitamin D significantly increase the risk of death in older adults with hip fractures: a prospective cohort. Rev Col Bras Cir. 2022;49. doi:10.1590/0100-6991e-20223054
Bonnici M, Ong N, Cordina J, Ferry P. Post Hip Fracture Treatment: Evaluation of a Rehabilitation Hospital in Malta. Geriatr Orthop Surg Rehabil. 2021;12:56. doi:10.1177/21514593211058764
Manoj P, Derwin R, George S. What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta-analysis. Int J Older People Nurs. 2023;18(1). doi:10.1111/opn.12492
Jarusriwanna A, Phusunti S, Chotiyarnwong P, Unnanuntana A. High-dose versus low-dose ergocalciferol for correcting hypovitaminosis D after fragility hip fracture: a randomized controlled trial. BMC Geriatr. 2021;21(1):72. doi:10.1186/s12877-021-02023-1
Araiza-Nava B, Méndez-Sánchez L, Clark P, et al. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporosis International. 2022;33(7):1429-1444. doi:10.1007/s00198-022-06346-6
Teh JW, Mac Gearailt C, Lappin DWP. Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management. Int J Mol Sci. 2024;25(3). doi:10.3390/ijms25031859
Cianferotti L, Bifolco G, Caffarelli C, et al. Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review. Nutrients. 2024;16(11). doi:10.3390/nu16111773
Leboff MS, Bischoff-Ferrari HA. The Effects of Vitamin D Supplementation on Musculoskeletal Health: The VITAL and DO-Health Trials. Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2023;78:73-78. doi:10.1093/gerona/glad073
Murashima M, Hamano T, Nishiyama T, et al. Performance Status Modifies the Association Between Vitamin D Receptor Activator and Mortality or Fracture: A Prospective Cohort Study on the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry. Journal of Bone and Mineral Research. 2022;37(8):1489-1499. doi:10.1002/jbmr.4621
Fink A, Puchwein P, Fahrleitner-Pammer A, Eder-Halbedl M, Bernhardt GA. Increased Early Postoperative Complication Rate after Osteoporotic Hip Fracture in Patients with Low 25 (OH) Vitamin D Levels. Nutrients. 2024;16(12). doi:10.3390/nu16121917
Martín-Nieto A, Chana-Valero P, Ruiz-Tovar J, et al. Nutritional Status Impact on Hip Fracture Patients in a Rural Environment. Nutrients . 2024;16(21). doi:10.3390/nu16213622
Wang K, Xia C, Zhou L, Zheng Y, Wang X, Cheng L. The Association between Vitamin D Deficiency and the Risk of Mortality after Hip Fractures: A Systematic Review and Meta-Analysis. J Nutr Sci Vitaminol (Tokyo). 2024;70(2):89-97. doi:10.3177/jnsv.70.89
Meng L, Wang X, Carson JL, Schlussel Y, Shapses SA. Vitamin D Binding Protein and Postsurgical Outcomes and Tissue Injury Markers After Hip Fracture: A Prospective Study. Journal of Clinical Endocrinology and Metabolism. 2024;109(1):E18-E24. doi:10.1210/clinem/dgad502
Hao L, Carson JL, Schlussel Y, Noveck H, Shapses SA. Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: A prospective study. American Journal of Clinical Nutrition. 2020;112(3):613-618. doi:10.1093/ajcn/nqaa029
Brzeszczyński F, Hamilton D, Bończak O, Brzeszczyńska J. Systematic Review of Sarcopenia Biomarkers in Hip Fracture Patients as a Potential Tool in Clinical Evaluation. Int J Mol Sci. 2024;25(24). doi:10.3390/ijms252413433
Bayram JM, Kanesan H, Clement ND. Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk. European Journal of Orthopaedic Surgery and Traumatology. 2025;35(1). doi:10.1007/s00590-024-04162-8
Rabiee Rad M, Ghasempour Dabaghi G, Afshari Safavi A, Moshkdar P, Akbariaghdam H. Adjuvant Vitamin D Injection in Elderly Patients Before Intertrochanteric Fracture Surgery: A Randomised Controlled Trial. Geriatr Orthop Surg Rehabil. 2024;15. doi:10.1177/21514593231220769
Cappola AR, Abraham DS, Kroopnick JM, et al. Sex-specific associations of vitamin D and bone biomarkers with bone density and physical function during recovery from hip fracture: the Baltimore Hip Studies. Osteoporosis International. 2025;36(5):855-863. doi:10.1007/s00198-025-07446-9
Gatt T, Grech A, Arshad H. The Effect of Vitamin D Supplementation for Bone Healing in Fracture Patients: A Systematic Review. Adv Orthop. 2023;2023. doi:10.1155/2023/6236045
Song M, Wang Y, Jiang Y, Pi H, Lyu H, Gao Y. Risk factors for subsequent fractures in hip fracture patients: a nested case-control study. J Orthop Surg Res. 2024;19(1). doi:10.1186/s13018-024-04833-6
Llombart R, Mariscal G, Barrios C, de la Rubia Ortí JE, Llombart-Ais R. Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies. J Endocrinol Invest. 2024;47(6):1323-1334. doi:10.1007/s40618-023-02266-2
Giustina A, Giustina A. Vitamin D and hip protectors in osteosarcopenia: a combined hip fracture preventing approach. Rev Endocr Metab Disord. 2025;26(1):1-18. doi:10.1007/s11154-024-09907-8
Ceolin C, Sella S, Simonato C, et al. Impact of multidimensional assessment on anti-fracture treatment decisions in patients with fragility hip fractures within a Fracture Liaison Service. BMC Geriatr. 2025;25(1). doi:10.1186/s12877-025-06009-1
Zora H, Bayrak G. An exploration of serum 25-hydroxyvitamin D levels after unstable femoral intertrochanteric fractures in community-dwelling elderly. Saudi Med J. 2025;46(4):372-377. doi:10.15537/smj.2025.46.4.20241121
Moran JM, Trigo-Navarro L, Diestre-Morcillo E, Pastor-Ramon E, Puerto-Parejo LM. Nutritional Interventions for Pressure Ulcer Prevention in Hip Fracture Patients: A Systematic Review and Meta-Analysis of Controlled Trials. Nutrients. 2025;17(4). doi:10.3390/nu17040644
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