Xie Zhongjian, Xia Weibo, Zhang Zhenlin, Wu Wen, Lu Chunyan, Tao Shuqing, Wu Lijun, Gu Jiemei, Chandler Julie, Peter Senaka, Yuan Hang, Wu Ting, Liao Eryuan
Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Endocrinology, Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Front Endocrinol (Lausanne). 2019 Jan 7;9:782. doi: 10.3389/fendo.2018.00782. eCollection 2018.
We aimed to investigate the status of serum 25-hydroxyvitamin D [25(OH)D] among Chinese postmenopausal women in a multicenter cross-sectional study. Non-institutionalized postmenopausal women aged ≥55 years were recruited from urban and rural areas in 7 geographically different regions in China. Subject enrollment was executed during the summer and the winter. Vitamin D insufficiency and deficiency were defined as 25(OH)D < 30 and< 20 ng/ml, and was measured by liquid chromatography-tandem mass spectrometry. Women were referred to a dual-energy x-ray absorptiometry (DXA) if they had a medium-to-high fracture risk suggested by Osteoporosis Self-Assessment Tool for Asians (OSTA). Among all subjects, 91.2% (1,535/1,684, 95%CI: 89.7, 92.5) had vitamin D insufficiency and 61.3% had vitamin D deficiency (1,033/1,684, 95%CI: 59.0, 63.7). The prevalence of vitamin D deficiency was significantly higher in urban dwellers (64.9 vs. 57.7% in rural, = 0.002) and in winter-enrolled subjects (84.7 vs. 41.3% in summer, < 0.0001). The prevalence of vitamin D inadequacy did not increase in trend by latitude and was numerically lower in women who had high fracture risk and osteoporosis. A non-curvilinear change of intact parathyroid hormone (iPTH) levels was observed at 25(OH)D >16.78 ng/mL. The prevalence of vitamin D inadequacy was remarkable among Chinese postmenopausal women and independent of fracture risk assessed by OSTA or osteoporosis suggested by DXA. Winter season, urban residence, however not latitude, were significantly associated with a higher likelihood of vitamin D deficiency. Optimal vitamin D status for iPTH and bone-related outcomes merits further investigation in this population.
在一项多中心横断面研究中，我们旨在调查中国绝经后女性血清25-羟维生素D [25(OH)D] 的状况。从中国7个地理区域的城乡地区招募年龄≥55岁的非机构化绝经后女性。在夏季和冬季进行受试者招募。维生素D不足和缺乏的定义为25(OH)D < 30 ng/ml和< 20 ng/ml，并通过液相色谱-串联质谱法进行测量。如果女性通过亚洲人骨质疏松自我评估工具（OSTA）提示有中到高骨折风险，则转诊至双能X线吸收法（DXA）检查。在所有受试者中，91.2%（1535/1684，95%CI：89.7，92.5）存在维生素D不足，61.3%存在维生素D缺乏（1033/1684，95%CI：59.0，63.7）。城市居民中维生素D缺乏的患病率显著更高（城市为64.9%，农村为57.7%，P = 0.002），冬季招募的受试者中维生素D缺乏的患病率也显著更高（冬季为84.7%，夏季为41.3%，P < 0.0001）。维生素D不足的患病率未随纬度呈趋势性增加，且在骨折风险高和患有骨质疏松症的女性中数值较低。当25(OH)D >16.78 ng/mL时，观察到完整甲状旁腺激素（iPTH）水平呈非曲线变化。中国绝经后女性中维生素D不足的患病率很高，且与OSTA评估的骨折风险或DXA提示的骨质疏松症无关。然而，冬季、城市居住环境而非纬度与维生素D缺乏的可能性显著相关。iPTH和骨相关结局的最佳维生素D状态值得在该人群中进一步研究。
