Lakkireddy Maheshwar, Mudavath Shashi Vardhan, Karra Madhu Latha, Arora Abhishek J
Department of Orthopaedics, Nizam's Institute of Medical sciences, Punjagutta, Hyderabad, Telangana 500082, India.
Department of Biochemistry, Nizam's Institute of Medical sciences, Punjagutta, Hyderabad, Telangana 500082, India.
J Clin Orthop Trauma. 2019 Jul-Aug;10(4):768-773. doi: 10.1016/j.jcot.2018.06.007. Epub 2018 Jun 22.
Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, increased bone turnover, bone loss and increased fracture risk. Vitamin D is well recognized to be suboptimal in older patients when compared to age-matched controls. There are no published studies on the prevalence of hypovitaminosis D in Indian population with fragility fractures around the hip associated with osteoporosis and comminution at the fracture site.
To investigate the prevalence of hypovitaminosis D in patients admitted with osteoporotic hip fractures and associated fracture site comminution in a South Indian Institute.
MATERIAL & METHODS: A prospective cross sectional study was conducted on 100 patients admitted with osteoporotic hip fracture. Measurement of serum 25-hydroxy vitamin D was done and the same was correlated with the degree of osteoporosis using Singh's index and fracture site comminution.
Out of 100 patients studied, 92% had hypovitaminosis D with mean vitamin D level of 16.08 ± 5.95 ng/dl (65% vitamin D deficiency with mean 13.16 ± 4.24 ng/dl and 27% vitamin D insufficiency with mean 23.11 ± 2.62 ng/dl) and 94% had osteoporosis with Singh's index grade 3 or less. Out of the 36 patients with fracture site comminution 34 patients (94%) had hypovitaminosis D and 33 patients (91.6%) had osteoporosis. Statistical significance was established for all the variables.
Significant association was found between hypovitaminosis D, osteoporosis and fracture site comminution. High prevalence of hypovitaminosis D in patients presenting with hip fractures and fracture site comminution implicates the necessity for proper evaluation and effective supplementation of vitamin D in elderly patients along with anti-osteoporotic regimens for effective prevention and appropriate management of osteoporotic hip fractures.
血清维生素D水平不足与继发性甲状旁腺功能亢进、骨转换增加、骨质流失及骨折风险增加相关。与年龄匹配的对照组相比，老年患者的维生素D水平普遍未达最佳状态。目前尚无关于印度人群中因骨质疏松症导致髋部脆性骨折且骨折部位粉碎的维生素D缺乏症患病率的公开研究。
调查在印度南部一家研究所收治的骨质疏松性髋部骨折及相关骨折部位粉碎患者中维生素D缺乏症的患病率。
对100例因骨质疏松性髋部骨折入院的患者进行前瞻性横断面研究。检测血清25-羟维生素D水平，并将其与使用辛格指数评估的骨质疏松程度及骨折部位粉碎情况进行关联分析。
在研究的100例患者中,92%患有维生素D缺乏症，维生素D平均水平为16.08±5.95 ng/dl（65%为维生素D缺乏，平均水平为13.16±4.24 ng/dl，27%为维生素D不足，平均水平为23.11±2.62 ng/dl），94%患有骨质疏松症，辛格指数为3级或更低。在36例骨折部位粉碎的患者中，34例（94%）患有维生素D缺乏症，33例（91.6%）患有骨质疏松症。所有变量均具有统计学意义。
维生素D缺乏症、骨质疏松症与骨折部位粉碎之间存在显著关联。髋部骨折及骨折部位粉碎患者中维生素D缺乏症的高患病率表明，老年患者除了采用抗骨质疏松治疗方案有效预防和妥善处理骨质疏松性髋部骨折外，还需要对维生素D进行适当评估和有效补充。
