Khadgawat Rajesh, Brar Krishnendra Singh, Gahlo Monita, Yadav Chandra Shekhar, Malhotra Rajesh, Guptat Nandita, Tandon Nikhil
Dept of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi--110029.
J Assoc Physicians India. 2010 Sep;58:539-42.
To assess vitamin D nutrition status in Asian-Indian patients with fragility hip fracture.
The study subjects included patients with non-traumatic hip fracture with age more than 50 years. Any patient who sustained fracture after road side accident of any severity was excluded. The other exclusion criteria were history of previous non-traumatic fracture or history of intake of systemic steroids, anti-osteoporotic medication, anti-tubercular or antiepileptic drugs. Routine biochemistry, serum 25-hydroxy vitamin D [25(OH)D] and BMD (DXA) were measured in all patients. Diagnosis of vitamin D deficiency (VDD) was considered when serum 25(OH)D levels were < 20 ng/ml. Age and sex matched apparently healthy subjects (without history of fracture at any site) were selected from general population. All controls under went BMD measurement at spine.
Final analysis included 43 patients, 9 men (20.9%) and 34 women (79.0%, all postmenopausal). The mean age of patients was 62.2 +/- 12.3 years (range 50.5 to 74.2 years, men--62 +/- 13.4 years; women--62.3 +/- 12.4 years; p 0.73). History of adequate sun exposure was obtained in 34.8% cases only. Fracture occurred while patients were outside home in 10/43 (23.25%) while 33/43 (76.7%) patients sustained fracture at home. Of all fractures occurring at home, 51.5% patients sustained fracture consequent to fall/slip in the bathroom. The mean serum 25(OH)D level was 9.9 +/- 4.8 ng/ml (range 5-21.5 ng/ml). All patients except one (96.7%) had VDD. No significant difference in serum 25(OH)D levels was observed between patients with and without adequate sun exposure. BMD of patients with fragility fractures were significantly low in comparison to BMD of healthy controls. (cases --0.790 +/- 0.1 gm/sq cm vs controls 0.924 +/- 0.1 gm/sq cm; p 0.000). The mean Z-score of spine BMD of cases was -1.13 +/- 1.4. No significant difference was observed in the BMD of patients with or without adequate sun exposure and with or without calcium and vitamin D supplementation at the time of fracture. Similarly, no significant difference was noted in BMD of patients with severe VDD and patients with mild to moderate VDD. All patients were contacted by telephone one year after the surgery (mean 12.3 months, range 9 to 13 months). Out of total 43 patients, 26 patients/families could be contacted, 11 (42.3%) died within one year of surgery, of which 8 patients died within first 6 months after surgery. Two patients died within 72 hours after discharge from hospital. Of 15 patients alive one year after surgery, two were able to walk without any support while 13 were able to walk with some support (stick or walker).
Our study shows very high prevalence (96.7%) of vitamin D deficiency in Asian-Indian patients with fragility hip fracture. The BMD of these patients is significantly low in comparison to age and sex matched healthy controls. More fractures occurred at home than outside, with a majority of fall being in the bathroom.
评估亚洲印度裔脆性髋部骨折患者的维生素D营养状况。
研究对象包括年龄超过50岁的非创伤性髋部骨折患者。排除任何严重程度的路边事故后发生骨折的患者。其他排除标准为既往非创伤性骨折史或全身用类固醇、抗骨质疏松药物、抗结核或抗癫痫药物摄入史。对所有患者进行常规生化检查、血清25-羟基维生素D[25(OH)D]和骨密度（双能X线吸收法）测量。当血清25(OH)D水平<20 ng/ml时，考虑诊断为维生素D缺乏（VDD）。从普通人群中选取年龄和性别匹配的明显健康受试者（无任何部位骨折史）。所有对照者均进行了脊柱骨密度测量。
最终分析纳入43例患者，9例男性（20.9%），34例女性（79.0%，均为绝经后女性）。患者的平均年龄为62.2±12.3岁（范围50.5至74.2岁，男性62±13.4岁；女性62.3±12.4岁；p=0.73）。仅34.8%的病例有充足日照史。43例中有10例（23.25%）患者在户外时发生骨折，33例（76.7%）患者在家中发生骨折。在家中发生的所有骨折中，51.5%的患者因在浴室跌倒/滑倒而骨折。血清25(OH)D平均水平为9.9±4.8 ng/ml（范围5至21.5 ng/ml）。除1例患者外，所有患者（96.7%）均有VDD。有充足日照和无充足日照的患者血清25(OH)D水平无显著差异。与健康对照者的骨密度相比，脆性骨折患者的骨密度显著降低。（病例组0.790±0.1 g/cm²，对照组0.924±0.1 g/cm²；p=0.000）。病例组脊柱骨密度的平均Z值为-1.13±1.4。骨折时有无充足日照、有无补充钙和维生素D的患者骨密度无显著差异。同样，重度VDD患者和轻度至中度VDD患者的骨密度也无显著差异。术后一年通过电话联系所有患者（平均12.3个月，范围9至13个月）。43例患者中，26例患者/家属可联系到，11例（42.3%）在术后一年内死亡，其中8例在术后前6个月内死亡。2例患者在出院后72小时内死亡。术后一年存活的15例患者中，2例能够独立行走，13例需要借助辅助工具（拐杖或助行器）行走。
我们的研究表明，亚洲印度裔脆性髋部骨折患者维生素D缺乏的患病率非常高（96.7%）。与年龄和性别匹配的健康对照者相比，这些患者的骨密度显著降低。在家中发生的骨折多于户外，大多数跌倒发生在浴室。
