Bone Metabolism Laboratory, Rheumatology Division and Department of Psychiatry, Section of Epidemiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Maturitas. 2009 Dec 20;64(4):218-22. doi: 10.1016/j.maturitas.2009.09.020. Epub 2009 Oct 17.
To determine the risk factors for the presence of moderate/severe vertebral fracture, specifically 25-hydroxyvitamin D (25-OHD).
Cross-sectional study conducted for 2 years in the city of São Paulo, Brazil including community-dwelling elderly women.
Bone mineral density (BMD), serum 25-OHD, intact parathyroid hormone (iPTH), calcium and estimated glomerular filtration rate (eGFR) were examined in 226 women without vertebral fractures (NO FRACTURE group) and 189 women with at least one moderate/severe vertebral fracture (FRACTURE group). Vertebral fracture assessment (VFA) was evaluated using both the Genant semiquantitative (SQ) approach and morphometry.
Patients in the NO FRACTURE group had lower age, increased height, higher calcium intake, and higher BMD compared to those patients in the FRACTURE group (p<0.05). Of interest, serum levels of 25-OHD in the NO FRACTURE group were higher than those observed in the FRACTURE group (51.73 nmol/L vs. 42.31 nmol/L, p<0.001). Reinforcing this finding, vitamin D insufficiency (25-OHD<75 nmol/L) was observed less in the NO FRACTURE group (82.3% vs. 93.65%, p=0.001). After adjustment for significant variables within the patient population (age, height, race, calcium intake, 25-OHD, eGFR and sites BMD), the logistic-regression analyses revealed that age (OR=1.09, 95% CI 1.04-1.14, p<0.001) femoral neck BMD (OR=0.7, 95% CI 0.6-0.82, p<0.001) and 25-OHD <75 nmol/L (OR=2.38, 95% CI 1.17-4.8, p=0.016) remains a significant factor for vertebral fracture.
Vitamin D insufficiency is a contributing factor for moderate/severe vertebral fractures. This result emphasizes the importance of including this modifiable risk factor in the evaluation of elderly women.
确定存在中度/重度椎体骨折的风险因素，特别是 25-羟维生素 D（25-OHD）。
这项为期 2 年的横断面研究在巴西圣保罗市进行，纳入了社区居住的老年女性。
对 226 名无椎体骨折的女性（无骨折组）和 189 名至少有 1 处中度/重度椎体骨折的女性（骨折组）进行了骨密度（BMD）、血清 25-OHD、完整甲状旁腺激素（iPTH）、钙和估算肾小球滤过率（eGFR）检查。采用 Genant 半定量（SQ）方法和形态计量学对椎体骨折评估（VFA）进行评估。
与骨折组相比，无骨折组患者年龄较小、身高较高、钙摄入量较高、BMD 较高（p<0.05）。有趣的是，无骨折组血清 25-OHD 水平高于骨折组（51.73 nmol/L 比 42.31 nmol/L，p<0.001）。进一步证实这一发现，无骨折组维生素 D 不足（25-OHD<75 nmol/L）的发生率较低（82.3%比 93.65%，p=0.001）。在对患者人群中的显著变量（年龄、身高、种族、钙摄入量、25-OHD、eGFR 和 BMD 部位）进行调整后，逻辑回归分析显示，年龄（OR=1.09，95%CI 1.04-1.14，p<0.001）、股骨颈 BMD（OR=0.7，95%CI 0.6-0.82，p<0.001）和 25-OHD<75 nmol/L（OR=2.38，95%CI 1.17-4.8，p=0.016）仍然是椎体骨折的显著因素。
维生素 D 不足是导致中度/重度椎体骨折的一个因素。这一结果强调了在评估老年女性时纳入这一可改变的危险因素的重要性。
