Martinelli V, Dell'Atti C, Ausili E, Federici E, Magarelli N, Leone A, Massimi L, Di Rocco C, Bonomo L, Rendeli C
Department of Bioimaging and Radiological Sciences, Catholic University, 00168, Rome, Italy,
Childs Nerv Syst. 2015 Aug;31(8):1361-5. doi: 10.1007/s00381-015-2726-2. Epub 2015 May 1.
The aim of our study was to investigate the relationship between bone mineral density (BMD), vitamin D, and electrolyte blood values in patients with spina bifida, to find a possible therapeutic regimen and an intervention to reduce the risk of fractures in this population.
BMD values were measured in 49 patients (32 females, 17 males; aged 14.1 ± 3.86 years; range 5-20 years) using dual-energy X-ray absorptiometry (DEXA) and were analyzed based on sex, the level of spinal involvement, vitamin D, and electrolyte values, physical activity, body mass index (BMI), and ambulatory status [patients were divided into three subgroups: full-time wheelchair (FTWC), limited ambulator (LA), and full-time ambulator (FTA)]. These data were analyzed considering sex-, age-, and BMD-matched values and compared with those of normal population.
BMD was significantly lower in these patients compared with that in the general healthy population (Z-score: -1.2 ± 1.8); in particular, females had Z-score values significantly lower that of the males (Z-score: -2.43 ± 2.02; P < 0.0004). In FTWC subgroup, Z-score was lower than that of the other two subgroups (P < 0.009). Vitamin D values were significantly lower compared with those in the general healthy population (vitamin D spina bifida group: 14.6 ± 8.7 mg/dL; normal subjects: 35 ± 9.8 mg/dL; P < 0.001). Subjects with spina bifida showed hypophosphatemia (<3 mg/dL) because of the lower levels of vitamin D (3.1 ± 0.9 mg/dL; P < 0.001).
Spina bifida patients showed lower BMD, vitamin D, and electrolyte values than the healthy population; hence, they have an increase risk of developing pathological fractures. Vitamin D supplementation for a longer time period could reduce this risk.
本研究旨在调查脊柱裂患者的骨密度（BMD）、维生素D和血液电解质值之间的关系，以寻找一种可能的治疗方案和干预措施，降低该人群骨折风险。
使用双能X线吸收法（DEXA）测量了49例患者（32例女性，17例男性；年龄14.1±3.86岁；范围5 - 20岁）的骨密度值，并根据性别、脊柱受累程度、维生素D和电解质值、身体活动、体重指数（BMI）及行走状态进行分析（患者分为三个亚组：全职轮椅使用者（FTWC）、有限行走者（LA）和全职行走者（FTA））。考虑到性别、年龄和骨密度匹配值对这些数据进行分析，并与正常人群的数据进行比较。
与一般健康人群相比，这些患者的骨密度显著降低（Z值：-1.2±1.8）；特别是，女性的Z值显著低于男性（Z值：-2.43±2.02；P<0.0004）。在FTWC亚组中，Z值低于其他两个亚组（P<0.009）。与一般健康人群相比，维生素D值显著降低（脊柱裂组维生素D：14.6±8.7mg/dL；正常受试者：35±9.8mg/dL；P<0.001）。由于维生素D水平较低，脊柱裂患者出现低磷血症（<3mg/dL）（3.1±0.9mg/dL；P<0.001）。
脊柱裂患者的骨密度、维生素D和电解质值低于健康人群；因此，他们发生病理性骨折的风险增加。长期补充维生素D可降低这种风险。
