Papaioannou Ioannis, Pantazidou Georgia, Kostoglou-Athanasiou Ifigeneia, Korovessis Panagiotis
Orthopedics and Traumatology, General Hospital of Patras "Agios Andreas", Patras, GRC.
Otolaryngology-Head and Neck Surgery, General Hospital of Patras "Agios Andreas", Patras, GRC.
Cureus. 2020 Aug 11;12(8):e9657. doi: 10.7759/cureus.9657.
Introduction Vitamin D (VD) deficiency seems to be an underestimated public health issue, especially in countries with a significant duration of sunlight throughout the year, as in this sunny Mediterranean region where this cross-sectional observational study was held. This study was conducted to assess the hypothesis that a higher prevalence of hypovitaminosis D exists in the elderly population with a hip fracture as compared with patients with knee/hip osteoarthritis or lumbar spondylosis in a south-western Mediterranean region. Methods This study included 61 consecutive patients with a mean age of 83 years who sustained a hip fracture (Group A). Sixty patients, with an average age of 73 years, who suffered from degenerative hip/knee osteoarthritis or lumbar spondylosis were subsequently selected as the control group (Group B). Parathyroid hormone (PTH) and 25-hydroxy VD blood levels were measured. Results Ninety-six point seven percent (96.7%; 59/61) of the individuals with hip fracture and 81.7% (49/60) in the controls were found with abnormal VD values (<30 ng/ml). The comparison of vitamin D values between the total samples of group A and B revealed a statistically significant difference (unpaired t-test, p<0.0001) while both male (p=0.0049) and female (p<0.0001) individuals in group A also showed statistically significant lower VD levels than their counterparts did. In addition, increased levels of parathormone were observed in women of group A (p=0.0016) and, therefore, for group A in the total sample (p=0.0004) while no statistical significance was observed in males (p=0.7712). Age was found to be an independent risk factor for VD deficiency in both groups (Group A p=0.04, Group B p=0.043). It is noteworthy that only four patients from group B (6, 67%) and none from group A had undergone blood tests for VD and PTH evaluation before hospital admission. Conclusions Τhe results confirmed the initial hypothesis of the study. Although VD hypovitaminosis concerns the majority of elderly living in this south-western Mediterranean region, the authors suggest VD and PTH measurements regardless of annual insolation, to identify and counsel the elderly with an increased risk of hip fracture and to avoid perioperative complications in patients who undergo elective orthopedic surgeries.
引言 维生素D（VD）缺乏似乎是一个被低估的公共卫生问题，特别是在全年日照时间较长的国家，比如本次横断面观察性研究开展的阳光充足的地中海地区。本研究旨在评估以下假设：在地中海西南部地区，髋部骨折的老年人群中维生素D缺乏症的患病率高于膝/髋骨关节炎或腰椎间盘突出症患者。方法 本研究纳入了61例平均年龄83岁的连续髋部骨折患者（A组）。随后选取了60例平均年龄73岁、患有退行性髋/膝骨关节炎或腰椎间盘突出症的患者作为对照组（B组）。检测甲状旁腺激素（PTH）和25-羟维生素D的血药浓度。结果 髋部骨折患者中有96.7%（59/61）的维生素D值异常（<30 ng/ml），对照组中这一比例为81.7%（49/60）。A组和B组总样本的维生素D值比较显示出统计学显著差异（非配对t检验，p<0.0001），A组男性（p=0.0049）和女性（p<0.0001）的维生素D水平也均显著低于对照组。此外，A组女性的甲状旁腺激素水平升高（p=0.0016），因此A组总样本也升高（p=0.0004），而男性无统计学差异（p=0.7712）。年龄是两组维生素D缺乏的独立危险因素（A组p=0.04，B组p=0.043）。值得注意的是，入院前B组仅4例患者（6.67%）进行了维生素D和PTH评估的血液检查，A组无患者进行。结论 结果证实了本研究的初始假设。尽管维生素D缺乏症在居住于地中海西南部地区的大多数老年人中都存在，但作者建议无论年日照情况如何，都应检测维生素D和PTH，以识别并为髋部骨折风险增加的老年人提供咨询，并避免接受择期骨科手术患者的围手术期并发症。
