Fu Xing-Mao, Fan Shao-Guang, Li Shu-Liang, Chen Yi-Sheng, Wu Hai, Guo Yan-Long
Institute of Traumatic Orthopedics, The 89th Hospital of People's Liberation Army, No. 256 Beigongxi Str, Weifang, 261021, Shandong Province, People's Republic of China.
J Transl Med. 2015 Dec 23;13:388. doi: 10.1186/s12967-015-0756-x.
There is limited information on the prevalence of vitamin D deficiency among patients diagnosed with hip fracture in the Chinese Han population. Therefore, the aim of this study was to assess the effects of change in the serum levels of 25-hydroxyvitamin D [25(OH) D] and intact parathyroid hormone (iPTH) among postmenopausal women in North China with confirmed hip fracture.
This study was done from May 1, 2012 to April 30, 2014. Three hundred and forty-nine postmenopausal women who were diagnosed with first-ever hip fracture and 349 matched controls without fracture were used for this study. The 25(OH) D, iPTH, alkaline phosphatase, calcium, and phosphorus levels were measured in fasting venous blood samples collected from the subjects. A predesigned questionnaire was used to collect information on covariates for multivariate analyses to evaluate the hypothesized relationship between vitamin D deficiency and fracture risk.
The serum 25(OH) D levels were found to be significantly (P < 0.0001) lower in hip fracture patients than in the controls [37.0 (interquartile range [IQR] 28.0-48.0) nmol/L vs. 41.3 (IQR 32.0-54.5) nmol/L; P < 0.0001], and the iPTH levels were significantly higher in the former group [10.2 (IQR 6.3-14.9) pmol/L vs. 5.8 (IQR 4.1-6.6) pmol/L; P < 0.0001]. Further, a 25(OH) D level ≤50 nmol/L was found to independently indicate the occurrence of hip fracture [odds ratio (OR), 3.023; 95 % confidence interval (CI) 2.154-4.298], as well as hip fracture with concomitant upper limb fracture (OR 4.473; 95 % CI 2.984-10.532). Similarly, a serum iPTH level ≥6.8 pmol/L independently indicated the development of hip fracture (OR 2.498; 95 % CI 1.764-3.942), as well as hip fracture with concomitant upper limb fracture (OR 3.254; 95 % CI 1.998-7.984).
Vitamin D insufficiency and secondary hyperparathyroidism were found to be common problems in the sample of postmenopausal women who had experienced hip fracture. Monitoring the alterations in the serum levels of 25(OH) D and iPTH could be applied clinically as independent risk factors for hip fracture.
关于中国汉族人群中髋部骨折患者维生素D缺乏症患病率的信息有限。因此，本研究的目的是评估中国北方确诊为髋部骨折的绝经后女性血清25-羟维生素D[25(OH)D]和完整甲状旁腺激素(iPTH)水平变化的影响。
本研究于2012年5月1日至2014年4月30日进行。349例首次诊断为髋部骨折的绝经后女性和349例匹配的无骨折对照者纳入本研究。从受试者采集的空腹静脉血样本中测量25(OH)D、iPTH、碱性磷酸酶、钙和磷水平。使用预先设计的问卷收集协变量信息，用于多变量分析，以评估维生素D缺乏与骨折风险之间的假设关系。
发现髋部骨折患者的血清25(OH)D水平显著低于对照组(P<0.0001)[37.0(四分位间距[IQR]28.0 - 48.0)nmol/L对41.3(IQR 32.0 - 54.5)nmol/L；P<0.0001]，且前一组的iPTH水平显著更高[10.2(IQR 6.3 - 14.9)pmol/L对5.8(IQR 4.1 - 6.6)pmol/L；P<0.0001]。此外，发现25(OH)D水平≤50 nmol/L独立表明髋部骨折的发生[比值比(OR)，3.023；95%置信区间(CI)2.154 - 4.298]，以及伴有上肢骨折的髋部骨折(OR 4.473；95%CI 2.984 - 10.532)。同样，血清iPTH水平≥6.8 pmol/L独立表明髋部骨折的发生(OR 2.498；95%CI 1.764 - 3.942)，以及伴有上肢骨折的髋部骨折(OR 3.254；95%CI 1.998 - 7.984)。
维生素D不足和继发性甲状旁腺功能亢进是经历髋部骨折的绝经后女性样本中的常见问题。监测血清25(OH)D和iPTH水平的变化可作为髋部骨折的独立危险因素应用于临床。
