Lee Sun Bin, Lee Chang Ho, Kim Young Ju, Kim Hyoung-Mi
Otorhinolaryngology Department, CHA University, Seongnam, Korea.
PLoS One. 2017 May 3;12(5):e0176011. doi: 10.1371/journal.pone.0176011. eCollection 2017.
Several studies have suggested a possible relationship between recurrent benign paroxysmal positional vertigo (BPPV) and altered calcium homeostasis in the endolymph of the inner ear. The present study aimed to evaluate the association between Ca2+ and vitamin D status and BPPV occurrence as well as the status of bone biochemical markers in osteoporotic patients who were diagnosed with idiopathic BPPV.
The study included total 132 patients who were referred to our clinic between August 2008 and October 2013. Based on the bone mineral density (BMD) results, the subjects were divided into three groups: normal BMD (n = 34), osteopenia (n = 40) and osteoporosis (n = 58). The biochemical markers of bone turnover including serum Carboxy-terminal telopeptide of type I collagen (s-CTX), osteocalcin, alkaline phosphatase (ALP) and urinary free deoxypyridinoline (u-DPD), were analyzed, along with the serum Ca2+ and vitamin D levels.
The mean serum calcium, phosphate and creatinine clearance levels were within the standard laboratory reference range. The incidence of vitamin D deficiency was 11.8% (4/34) in the normal BMD group, 15% (6/40) in the osteopenia group and 43.1% (25/58) in the osteoporosis group. There was a positive correlation between the 25(OH)D and BMD results in the patients with BPPV. Among the bone turnover markers, the osteocalcin and u-DPD levels were significantly elevated in the osteoporotic patients with BPPV. Multiple logistic regression analyses showed that osteoporosis and vitamin D deficiency were associated with BPPV.
Our findings suggest that the prevalence of BPPV in osteoporotic patients is associated with vitamin D deficiency and high bone turnover rates at systemic level, which could disturb local Ca2+ homeostasis in the inner ear.
多项研究表明，复发性良性阵发性位置性眩晕（BPPV）与内耳内淋巴中钙稳态改变之间可能存在关联。本研究旨在评估钙和维生素D状态与BPPV发生之间的关联，以及诊断为特发性BPPV的骨质疏松患者的骨生化标志物状态。
该研究共纳入了2008年8月至2013年10月间转诊至我们诊所的132例患者。根据骨密度（BMD）结果，将受试者分为三组：正常骨密度组（n = 34）、骨量减少组（n = 40）和骨质疏松组（n = 58）。分析了骨转换的生化标志物，包括血清I型胶原羧基末端肽（s-CTX）、骨钙素、碱性磷酸酶（ALP）和尿游离脱氧吡啶啉（u-DPD），以及血清钙和维生素D水平。
血清钙、磷和肌酐清除率的平均水平在标准实验室参考范围内。正常骨密度组维生素D缺乏的发生率为11.8%（4/34），骨量减少组为15%（6/40），骨质疏松组为43.1%（25/58）。BPPV患者中25（OH）D与BMD结果之间存在正相关。在骨转换标志物中，BPPV的骨质疏松患者骨钙素和u-DPD水平显著升高。多因素逻辑回归分析表明，骨质疏松和维生素D缺乏与BPPV有关。
我们的研究结果表明，骨质疏松患者中BPPV的患病率与维生素D缺乏和全身高水平的骨转换率有关，这可能会扰乱内耳局部的钙稳态。
