Division of Endocrinology, Clementino Fraga Filho University Hospital, UFRJ, Rio de Janeiro, Rio de Janeiro, Brasil.
Division of Reumathology, Clementino Fraga Filho University Hospital, UFRJ, Rio de Janeiro, Rio de Janeiro, Brasil.
Eur J Endocrinol. 2019 Nov;181(5):509-517. doi: 10.1530/EJE-19-0197.
The role of vitamin D on bone microarchitecture and fragility is not clear.
To investigate whether vitamin D deficiency (25(OH)D <20 ng/mL) increases cortical bone loss and the severity of fractures.
Cross-sectional study of 287 elderly women with at least one prevalent low-impact fracture.
Biochemistry, X-rays to identify vertebral fractures (VFs) and to confirm non-vertebral fractures (NonVFs), and high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone microstructure.
Serum 25(OH)D levels were associated with body mass index (BMI: r = -0.161, P = 0.006), PTH (r = -0.165; P = 0.005), CTX (r = -0.119; P = 0.043) and vBMD at cortical bone (Dcomp: r = 0.132; P = 0.033) and entire bone (D100: r = 0.162 P = 0.009) at the distal radius, but not at the tibia. Age and PTH levels were potential confounding variables, but in the multiple linear regressions only BMI (95% CI: 0.11-4.16; P < 0.01), 25(OH)D (95% CI: -0.007 to 1.70; P = 0.05) and CTX (95% CI: -149.04 to 21.80; P < 0.01) predicted Dcomp, while BMI (95% CI: 1.13-4.18; P < 0.01) and 25(OH)D (95% CI: 0.24-1.52; P < 0.01) predicted D100. NonVFs predominated in patients with 25(OH)D <20 ng/mL (P = 0.013). Logistic regression analysis showed a decrease in the likelihood of presenting grade 2-3 VFs/NonVFs for every increase in 25(OH)D (OR = 0.962, 95% CI: 0.940-0.984; P = 0.001), BMI (OR = 0.932, 95% CI: 0.885-0.981; P = 0.007) and D100 at radius (OR = 0.994, 95% CI: 0.990-0.998; P = 0.005).
In elderly patients with prevalent fractures, vitamin D deficiency was associated with cortical bone loss and severity of fractures.
维生素 D 对骨微观结构和脆性的作用尚不清楚。
研究维生素 D 缺乏（25（OH）D <20ng/mL）是否会导致皮质骨丢失和骨折严重程度增加。
对 287 名至少有一处既往低强度骨折的老年女性进行横断面研究。
生化分析、X 射线确定椎体骨折（VF）并确认非椎体骨折（NonVF）、高分辨率外周定量计算机断层扫描（HR-pQCT）评估骨微观结构。
血清 25（OH）D 水平与体重指数（BMI：r = -0.161，P = 0.006）、甲状旁腺激素（PTH：r = -0.165；P = 0.005）、CTX（r = -0.119；P = 0.043）和桡骨远端皮质骨的 vBMD（Dcomp：r = 0.132；P = 0.033）以及整个骨的 D100（r = 0.162，P = 0.009）呈负相关，但与胫骨无关。年龄和 PTH 水平是潜在的混杂因素，但在多元线性回归中，只有 BMI（95%CI：0.11-4.16；P<0.01）、25（OH）D（95%CI：-0.007 至 1.70；P=0.05）和 CTX（95%CI：-149.04 至 21.80；P<0.01）可预测 Dcomp，而 BMI（95%CI：1.13-4.18；P<0.01）和 25（OH）D（95%CI：0.24-1.52；P<0.01）可预测 D100。25（OH）D<20ng/mL 的患者中非 VF 更为常见（P=0.013）。Logistic 回归分析显示，25（OH）D 每增加 1ng/mL，发生 2-3 级 VF/NonVF 的可能性降低（OR=0.962，95%CI：0.940-0.984；P=0.001），BMI（OR=0.932，95%CI：0.885-0.981；P=0.007）和桡骨 D100（OR=0.994，95%CI：0.990-0.998；P=0.005）。
在有既往骨折的老年患者中，维生素 D 缺乏与皮质骨丢失和骨折严重程度有关。
