与血清维生素 D 相比，游离维生素 D 与骨密度和胸腰椎交界处骨质疏松性椎体骨折相关性更好。
Free vitamin D correlate better with bone mineral density and thoracolumbar junction osteoporotic vertebral fractures than serum vitamin D.
机构信息
Department of Spine Surgery, the Third Affiliated Hospital, Sun Yat-Sen University, No.600 Tianhe Road, Guangzhou, 510630, Tianhe District, China.
Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Guangzhou, 510630, China.
出版信息
BMC Musculoskelet Disord. 2020 Mar 12;21(1):164. doi: 10.1186/s12891-020-3179-7.
BACKGROUND
Vitamin D deficiency has long been studied as a risk factor for osteoporosis. However, the association between serum vitamin D status, bone mineral density (BMD) and the incidence of vertebral fractures (OVFs) remain controversial. It is believed that free portion of the circulating vitamin D carries the metabolic activities of vitamin D. Therefore, the aim of the present study is to analyse if free vitamin D correlates with BMD and osteoporotic fragile vertebral fractures in the elderly population.
METHODS
A total of 90 consecutive patients, including 81 female and 9 male patients, aged > 48 years, were included in this cross sectional study between March and July of 2018. Total vitamin D (total 25(OH)D), free vitamin D (free 25(OH)D), calcium and phosphorus were measured. BMD was measured using dual energy X-ray absorptiometry (DEXA) and osteoporotic vertebral fracture was assessed using plain radiograph. Multiple linear regression was performed to find out the association between total vitamin D, free vitamin D and BMD at various sites. To evaluate the association with osteoporotic vertebral multivariate logistic regression model was used.
RESULTS
The mean total vitamin D and free vitamin D were 25.1 ± 10.2 and 6.1 ± 1.7 respectively. Free vitamin D had a linear correlation with total vitamin D (R = 0.69). While free vitamin D had a positive correlation with lumbar BMD roles (p < 0.05), total vitamin D didn't have any association with BMD at any site. Of the total patients, 62 patients (68.9%) had thoracolumbar junction OVFs. Free vitamin D level correlated with the prevalence of OVFs as well as lumbar osteoporosis (p < 0.05). However, there was no statistical correlation between serum vitamin D status and the OVFs.
CONCLUSIONS
Free vitamin D was significantly related to the occurrence of thoracolumbar junction OVFs and lumbar BMD, which assumed to be a positive predictor for fracture and osteoporosis prevention. However, total serum vitamin D levels did not have any association with BMD at different sites as well as fragile vertebral fracture.
TRIAL REGISTRATION
The study is registered at clinicaltrials.gov NCT03605173.
背景
维生素 D 缺乏症一直被研究为骨质疏松症的危险因素。然而，血清维生素 D 状态、骨密度 (BMD) 和椎体骨折 (OVFs) 的发生率之间的关系仍存在争议。人们认为循环维生素 D 的游离部分具有维生素 D 的代谢活性。因此，本研究旨在分析老年人群中游离维生素 D 是否与 BMD 和骨质疏松性脆弱性椎体骨折相关。
方法
本研究为 2018 年 3 月至 7 月期间进行的一项横断面研究，共纳入 90 例连续患者，其中 81 例女性和 9 例男性，年龄>48 岁。检测总维生素 D（总 25(OH)D）、游离维生素 D（游离 25(OH)D）、钙和磷。使用双能 X 射线吸收法 (DEXA) 测量 BMD，并使用 X 线平片评估骨质疏松性椎体骨折。进行多元线性回归以确定总维生素 D、游离维生素 D 与各部位 BMD 的关系。使用多变量逻辑回归模型评估与骨质疏松性椎体骨折的关系。
结果
总维生素 D 和游离维生素 D 的平均值分别为 25.1±10.2 和 6.1±1.7。游离维生素 D 与总维生素 D 呈线性相关 (R=0.69)。虽然游离维生素 D 与腰椎 BMD 呈正相关 (p<0.05)，但总维生素 D 与任何部位的 BMD 均无相关性。在所有患者中，62 例患者 (68.9%) 存在胸腰椎交界处 OVF。游离维生素 D 水平与 OVF 以及腰椎骨质疏松症的患病率相关 (p<0.05)。然而，血清维生素 D 状态与 OVF 之间无统计学相关性。
结论
游离维生素 D 与胸腰椎交界处 OVF 和腰椎 BMD 的发生显著相关，这被认为是骨折和骨质疏松症预防的阳性预测因子。然而，总血清维生素 D 水平与不同部位的 BMD 以及脆弱性椎体骨折均无相关性。
试验注册
该研究在 clinicaltrials.gov 注册，编号为 NCT03605173。
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