身体活动能力和季节对老年人25-羟基维生素D-甲状旁腺激素相互作用及骨重塑的影响。

Influence of physical mobility and season on 25-hydroxyvitamin D-parathyroid hormone interaction and bone remodelling in the elderly.

作者信息

Theiler R, Stähelin H B, Kränzlin M, Somorjai G, Singer-Lindpaintner L, Conzelmann M, Geusens P, Bischoff H A

机构信息

Departments of Rheumatology, University of Basel, Switzerland.

出版信息

Eur J Endocrinol. 2000 Nov;143(5):673-9. doi: 10.1530/eje.0.1430673.

DOI:10.1530/eje.0.1430673

PMID:11078992

Abstract

OBJECTIVE

To investigate influences of physical mobility and season on 25-hydroxyvitamin D-intact parathyroid hormone (iPTH) interaction in the elderly.

DESIGN

We examined 188 frail institutionalized elderly at the expected nadir of their serum vitamin D concentrations (winter). This group was compared with 309 healthy ambulatory elderly at the expected time of maximum vitamin D repletion (summer), to accentuate the influences of season and physical activity.

METHODS

Serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, iPTH and urinary deoxypyridinoline (DPD) were measured.

RESULTS

Vitamin D metabolites were significantly lower in the institutionalized elderly (P<0.0001), with an 82.5% prevalence of vitamin D deficiency (25-hydroxyvitamin D <12ng/ml) in institutionalized elderly in wintertime and 15.5% in ambulatory elderly in summertime. Overall, median iPTH did not differ between groups. However, median iPTH secretion in the presence of low vitamin D serum concentrations (5-30ng/ml) was greater in ambulatory elderly. This could be explained by lower mobility status being correlated with greater serum calcium concentrations (r=0.24, P=0.02 in women; r=0.35, P=0. 001 in men) and greater urinary excretion of DPD (r=0.41, P=0.0001 in women; r=0.42, P=0.0002 in men), independent of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and iPTH.

CONCLUSIONS

These data support the hypothesis that immobility, even in the presence of vitamin D deficiency, acts as an overriding influence on bone metabolism by promoting bone resorption (measured as urinary DPD) and increasing serum calcium independent of iPTH. Therefore mobility status may substantially affect 25-hydroxyvitamin D threshold values and the degree to which patients benefit from vitamin supplementation.

摘要

目的

探讨身体活动能力和季节对老年人25-羟维生素D-完整甲状旁腺激素（iPTH）相互作用的影响。

设计

我们在血清维生素D浓度预计最低值时（冬季）检查了188名身体虚弱的机构养老老年人。将该组与309名健康的能自主活动老年人在维生素D补充达到预期最大值时（夏季）进行比较，以突出季节和身体活动的影响。

方法

测量血清25-羟维生素D、1,25-二羟维生素D、iPTH和尿脱氧吡啶啉（DPD）的浓度。

结果

机构养老老年人的维生素D代谢产物显著较低（P<0.0001），冬季机构养老老年人维生素D缺乏（25-羟维生素D<12ng/ml）的患病率为82.5%，夏季能自主活动老年人为15.5%。总体而言，两组间iPTH中位数无差异。然而，血清维生素D浓度较低（5-30ng/ml）时，能自主活动老年人的iPTH分泌中位数更高。这可以解释为活动能力较低与血清钙浓度较高相关（女性r=0.24，P=0.02；男性r=0.35，P=0.001）以及DPD尿排泄量增加（女性r=0.41，P=0.0001；男性r=0.42，P=0.0002），且与25-羟维生素D、1,25-二羟维生素D和iPTH无关。