Optimal Vitamin D3 Supplementation Strategies for Acute Fracture Healing (Vita-Shock)
|ClinicalTrials.gov Identifier: NCT02786498|
Recruitment Status : Active, not recruiting
First Posted : June 1, 2016
Last Update Posted : September 14, 2020
|Condition or disease||Intervention/treatment||Phase|
|Fracture||Drug: Vitamin D3 Other: Placebo||Phase 2|
Vitamin D supplements are increasingly being recommended to healthy adult fracture patients without an osteoporotic injury. Although this is a relatively new practice pattern, the basis for this adjunct therapy is grounded in the high hypovitaminosis D prevalence rates (up to 75%) among healthy adult fracture patients, and the strong biologic rationale for the role of vitamin D in fracture healing. Briefly, experimental animal studies have demonstrated that the concentration of vitamin D metabolites is higher at a fracture callus compared to the uninjured contralateral bone, vitamin D supplementation leads to decreased time to union and increased callus vascularity, and increases mechanical bone strength compared to controls. While evidence to confirm that vitamin D supplementation improves fracture healing in clinical studies does not exist, the pre-clinical data are compelling and worthy of further investigation.
With modern orthopaedic surgical care, rates of complications following tibia and femoral shaft fractures can be as high as 15%. Complications, including delayed union, nonunion, or infection often require secondary surgical procedures and result in profound personal and societal economic costs. While surgeons continue to seek advances in surgical technique, it is becoming increasingly obvious that innovations in orthopaedic techniques or implants are unlikely to eliminate complications. As a result, considerable attention is currently focused on adjunct biologic therapies, such as vitamin D.
A recent survey of 397 orthopaedic surgeons showed that only 26% routinely prescribe vitamin D supplementation to adult fracture patients. Of the 93 surgeons who indicated that they routinely prescribe vitamin D supplementation, 29 different dosing regimens were described ranging from low daily doses of 400 IU to loading doses of 600,000 IU. This suggests a high level of clinical uncertainty surrounding the use and optimal dose of vitamin D supplementation in adult fracture patients. If vitamin D supplementation improves fracture healing outcomes, then there is a large opportunity to increase its use; however, before widespread adoption occurs, research is needed to optimize the dosing strategy, establish the dosing safety in the immobilized fracture healing population, and overcome potential medication adherence issues among the often marginalized patients that suffer trauma.
The long-term goal of our research program is to conduct a large phase III RCT to determine which dose of vitamin D3 supplementation optimally improves acute fracture healing outcomes in healthy adult patients (18-50 years). The current proposed phase II exploratory trial will perform important preliminary work to test the central hypothesis that vitamin D3 dose and timing of administration is critical for improving fracture healing at 3 months. This trial will also inform the feasibility of the large phase III RCT.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||96 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Triple (Participant, Investigator, Outcomes Assessor)|
|Official Title:||A Blinded Exploratory Randomized Controlled Trial to Determine Optimal Vitamin D3 Supplementation Strategies for Acute Fracture Healing|
|Actual Study Start Date :||November 21, 2016|
|Actual Primary Completion Date :||August 2019|
|Estimated Study Completion Date :||December 1, 2020|
Experimental: High Loading Dose
150,000 IU loading dose vitamin D3 at enrolment and 6 weeks, plus daily dose placebo for 3 months.
Drug: Vitamin D3
Experimental: High Daily Dose
Loading dose placebo at enrolment and 6 weeks, plus 4,000 IU vitamin D3 per day for 3 months.
Drug: Vitamin D3
Experimental: Low Daily Dose
Loading dose placebo at enrolment and 6 weeks, plus 600 IU vitamin D3 per day for 3 months.
Drug: Vitamin D3
Placebo Comparator: Control Group
Loading dose placebo at enrolment and 6 weeks, plus daily dose placebo for 3 months.
- Fracture healing will be assessed clinically using FIX-IT [ Time Frame: 3 months post-injury ]
- Fracture healing will be assessed radiographically using RUST [ Time Frame: 3 months post-injury ]
- Fracture healing will be assessed biochemically using serum levels of the bone turnover marker CTX [ Time Frame: 3 months post-injury ]
- Fracture healing will be assessed biochemically using serum levels of the bone turnover marker PINP [ Time Frame: 3 months post-injury ]
- Serum level of 25(OH)D [ Time Frame: Up to 3 months post-injury ]Correlations will be assessed between participants' 25(OH)D levels at enrolment, changes in 25(OH)D levels from enrolment to 3 months, and 25(OH)D levels at 3 months and fracture healing
- Patient self-report [ Time Frame: Up to 3 months post-injury ]Will measure adherence with vitamin D supplementation
- Adverse events [ Time Frame: Up to 12 months post-injury ]Will measure participant safety
- Serum levels of calcium [ Time Frame: Up to 12 months post-injury ]Will measure participant safety
- Serum levels of parathyroid hormone [ Time Frame: Up to 12 months post-injury ]Will measure participant safety
- Number of participants completing bloodwork and imaging outcome measures [ Time Frame: Up to 12 months post-injury ]Will measure adherence with the protocol
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02786498
|United States, Maryland|
|University of Maryland, R Adams Cowley Shock Trauma Center|
|Baltimore, Maryland, United States, 21201|
|McMaster University, Center for Evidence-Based Orthopaedics|
|Hamilton, Ontario, Canada, L8L 8E7|
|Principal Investigator:||Gerard Slobogean, MD||Unversity of Maryland|
|Principal Investigator:||Sheila Sprague, PhD||McMaster University|