SLR - May 2022 - Thi A. Pham, DPM
Reference: Mei, Z., Chen, G.-C., Hu, J., Lin, C., Sun, Z., Liu, C., Geng, X., Yuan, C., Qi, Q., & Zheng, Y. (2021). Habitual Use of Fish Oil Supplements, Genetic Predisposition, and Risk of Fractures: A Large Population-Based Study. The American Journal of Clinical Nutrition, 114(3), 945–954.Level of Evidence: Level II
Scientific Literature Review
Reviewed By: Thi A. Pham, DPM
Residency Program: New York College of Podiatric Medicine/Metropolitan Hospital Center – New York, NY
Podiatric Relevance: The potential risk of developing delayed unions or non-unions from fractures and various orthopedic procedures in foot and ankle surgery is one of the most encountered concerns when treating the elderly population. Extensive research has been done on effects of vitamin D levels on bone healing, but there is still inconclusive data extrapolated from investigations performed on a multitude of other nutritional supplements and their effects on bone healing, leading to no standardization of treatment. A look at one of those supplements, fish oil (omega-3 polyunsaturated fatty acids) is recently being considered and how routine intake of fish oil can have potential benefits on fracture healing and help decrease fracture risk in geriatric patients
Methods: This study is a level II evidence large cohort study that prospectively looked at the effects of fish oil supplementation on index fractures and recurrent fractures along with determining a correlation to genetic predisposition in the elderly population. The study focused on the UK Biobank, which is a population databank consisting of over 500,000 participants between the ages of 40–69 from the years 2006 to 2010 in the United Kingdom. Participants in the study completed a questionnaire, completed a face-to-face interview, provided various specimen and took a series of physical measurements. Exclusion criteria included anyone who withdrew from the study and any person who had insufficient data on fish oil use at baseline, which resulted in 3586 participants excluded out of study.
Results: The median follow-up was 8.1 years. The study found 12,070 fractures occurred in patients who never had a fracture before. Regular use of fish oil supplements was associated with a lower risk of total fractures (HR = 0.93; 95 percent CI: 0.89, 0.97), which was statistically significant, hip fractures (HR = 0.83; 95 percent CI: 0.75, 0.92), and vertebrae fractures (HR = 0.85; 95 percent CI: 0.72, 0.99). Participants that took fish oil regularly was associated with a lower risk of total recurrent fractures and vertebrae recurrent fractures but not with hip fracture recurrence.
Conclusions: According to this study, routine fish oil supplementation is associated with decreased risks of both incident and recurrent fractures. Those individuals not regularly supplementing with fish oil had a higher genetic predisposition to fracture development. Fish oil may also benefit in increase serum vitamin D levels and provide a synergistic effect on vitamin D metabolism