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Surgery
Research
Patient preferences for nutritional supplementation to improve fracture healing: a discrete choice experiment
  1. Elizabeth Nichols1,
  2. Nathan N O’Hara1,
  3. Yasmin Degani1,
  4. Sheila A Sprague2,
  5. Jonathan D Adachi3,
  6. Mohit Bhandari2,
  7. Michael F Holick4,
  8. Daniel W Connelly1,
  9. Gerard P Slobogean1
  1. 1 Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
  2. 2 Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Medicine, McMaster University, Hamilton, ON, Canada
  4. 4 Department of Medicine Endocrinology, Diabetes & Nutrition, Boston University, Boston, Massachusetts, USA
  1. Correspondence to Nathan N O’Hara; nohara{at}umoa.umm.edu

Abstract

Objective Vitamin D is often prescribed as an adjuvant therapy to aid fracture healing due to its biological role in bone health. However, the optimal frequency, dosage and duration of vitamin D supplementation for non-osteoporotic fracture healing has not been established. The objective of this study was to determine patient preferences for fracture healing relative to hypothetical vitamin D supplementation dosing options.

Design Discrete choice experiment.

Setting Level 1 trauma centre in Baltimore, Maryland, USA.

Participants 199 adult (18–60 years) patients with a fracture.

Primary outcome measures Parameter estimates of utility for fracture healing relative to dosing regimens were analysed using hierarchical Bayesian modelling.

Results A reduced risk of reoperation (34.3%) and reduced healing time (24.4%) were the attributes of greatest relative importance. The highest mean utility estimates were for a one-time supplementation dose (ß=0.71, 95% CI 0.41 to 1.00) followed by a reduced risk of reoperation (ß=0.41 per absolute % reduction, 95% CI 0.0.36 to 0.46). Supplementation for 24 weeks in duration (ß=−0.83, 95% CI −1.00 to −0.67) and a daily supplement (ß=−0.29, 95% CI −0.47 to −0.11) had the lowest mean utilities. The ‘no supplement’ option had a large negative value suggesting supplementation was generally desirable in this sample population. Among other possible clinical scenarios, patients expected a 2% reduction in the absolute risk of reoperation or a 3.1-week reduction in healing time from the baseline to accept a treatment regimen requiring two separate doses of supplementation, two blood tests and a cost of $20 within 3 months of injury.

Conclusions Patients with orthopaedic trauma demonstrated strong willingness to take a vitamin D supplement that would decrease risk of reoperation and reduce healing time. Furthermore, these findings specify the required decrease in reoperation risk and reduction in healing time patients would expect to adhere to possible vitamin D dosing regimens.

  • discrete choice experiment
  • vitamin D
  • fracture
  • preferences

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019685

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    Footnotes

    • Contributors EN contributed to the literature search, study design, data collection, data interpretation, writing and critical revision. NNO contributed to the literature search, study design, data analysis, data interpretation, writing and critical revision. YD, DWC contributed to the data collection, data interpretation and critical revision. SAS, JDA, MB, MFH and GPS contributed to the literature search, study design, data interpretation and critical revision. All authors have approved the final version of the article submitted and agree to be accountable for all aspects of the work.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests GPS reports payments for presenting by Zimmer Biomet.

    • Patient consent Obtained.

    • Ethics approval University of Maryland School of Medicine, Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.