Pieper Carl F, Colon-Emeric Cathleen, Caminis John, Betchyk Kathleen, Zhang Jie, Janning Cheri, Shostak John, LeBoff Meryl S, Heaney Robert R, Lyles Kenneth W
Center on Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Geriatr Pharmacother. 2007 Dec;5(4):335-40. doi: 10.1016/j.amjopharm.2007.12.004.
Vitamin D deficiency is common in older populations, particularly during the winter months due to low levels of ultraviolet light exposure, and in nursing home residents.
The main objective of the current study was to assess the distribution of serum 25-hydroxyvitamin D and its correlates in a sample of men and women with recent hip fractures who were part of a large clinical trial.
This was a cross-sectional exploratory study of screened and ultimately randomized patients with hip fractures. They were part of a multinational (115 clinical centers in 20 countries), randomized, placebo-controlled, double-blind study testing the efficacy of a yearly IV bisphosphonate (zoledronic acid) in the prevention of new clinical fractures in patients with recent hip fracture repair. Levels of 25-hydroxyvitamin D, calcium, alkaline phosphatase, creatinine clearance, and albumin were measured at a screening visit using blood serum. Demographic variables were assessed by patient self-report. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry of the nonfractured hip.
This report included 1174 screened patients (526 with vitamin D measured) and 655 (385 with vitamin D measured) patients randomized before the protocol amendment. In screened patients, levels of 25-hydroxyvitamin D were low (median, 14.7 ng/mL; interquartilc range, 7.6, 21.65). Overall, 51% were at or below the clinically meaningful threshold of 15 ng/mL. Among those patients randomized, the level of 25-hydroxyvitamin D was significantly positively related to male sex (rho, 0.13; P < 0.05), serum calcium (rho, 0.16; P < 0.01), and BMD at the femoral neck (rho, 0.22; P < 0.01) in bivariate analyses. Low serum 25-hydroxyvitamin D (<15 ng/mL) was related only to low serum calcium (odds ratio, 0.16; 95% CI, 0.05-0.52) in multivariable logistic models controlling for sex, age, race, body mass index, living at home, alkaline phosphatase, and creatinine clearance.
We concluded that vitamin D insufficiency was a common problem in this population of elderly patients who had recently suffered a hip fracture. This insufficiency was related only to serum calcium in multivariable controlled models but cannot be reliably identified or excluded by measuring serum calcium alone. Physicians should be encouraged to check and monitor patients' serum levels of 25-hydroxyvitamin D.
维生素D缺乏在老年人群中很常见，尤其是在冬季，因为紫外线暴露水平低，在疗养院居民中也是如此。
本研究的主要目的是评估参加一项大型临床试验的近期髋部骨折的男性和女性样本中血清25-羟维生素D的分布及其相关因素。
这是一项对筛选出的最终随机分组的髋部骨折患者进行的横断面探索性研究。他们是一项跨国（20个国家的115个临床中心）、随机、安慰剂对照、双盲研究的一部分，该研究测试了每年静脉注射双膦酸盐（唑来膦酸）对近期髋部骨折修复患者预防新的临床骨折的疗效。在筛查访视时使用血清测量25-羟维生素D、钙、碱性磷酸酶、肌酐清除率和白蛋白水平。人口统计学变量通过患者自我报告进行评估。通过对未骨折髋部进行双能X线吸收法评估骨密度（BMD）。
本报告包括1174名筛查患者（526名测量了维生素D）和655名（385名测量了维生素D）在方案修订前随机分组的患者。在筛查患者中，25-羟维生素D水平较低（中位数为14.7 ng/mL；四分位间距为7.6，21.65）。总体而言，51%的患者处于或低于15 ng/mL的临床有意义阈值。在那些随机分组的患者中，在双变量分析中，25-羟维生素D水平与男性性别（rho = 0.13；P < 0.05）、血清钙（rho = 0.16；P < 0.01）和股骨颈骨密度（rho = 0.22；P < 0.01）显著正相关。在控制性别、年龄、种族、体重指数、居家情况、碱性磷酸酶和肌酐清除率的多变量逻辑模型中，低血清25-羟维生素D（<15 ng/mL）仅与低血清钙相关（比值比为0.16；95%可信区间为0.05 - 0.52）。
我们得出结论，维生素D不足在近期发生髋部骨折的老年患者群体中是一个常见问题。在多变量控制模型中，这种不足仅与血清钙相关，但仅通过测量血清钙不能可靠地识别或排除。应鼓励医生检查和监测患者的血清25-羟维生素D水平。
