Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China.
Clin Interv Aging. 2020 Oct 15;15:1971-1978. doi: 10.2147/CIA.S271904. eCollection 2020.
Vitamin D (25[OH]D) status and bone turnover markers (BTMs) are considered important determinants of bone quality, which is associated with the risk of hip fractures, including both femoral neck and intertrochanteric fractures, in older adults; however, the exact relationship of 25(OH)D and BTMs with the type and severity of hip fractures remains unclear and the present study aimed to identify any specific associations.
According to the inclusion and exclusion criteria, 441 older female patients with hip fractures from 2015 to 2020 and 215 women without hip fractures were included in this cross-sectional study. According to Garden and AO/OTA classifications for femoral neck and intertrochanteric fractures, patients were divided into less severe (Garden I and Garden II; 31A1) and more severe (Garden III and Garden IV; 31A2 and 31A3) fracture groups. Levels of the serum osteoblast indicator, N-terminal/mid region (N-MID); the osteoclast indicator, beta-carboxy terminal telopeptide (β-CTX); and 25(OH)D were analyzed.
For patients with less severe fractures, mean 25(OH)D levels were significantly higher than those with more severe fractures (17.67 vs 15.30 ng/mL, p = 0.006). Higher 25(OH)D levels were also observed in patients with less severe intertrochanteric fractures (p = 0.01). After adjustments for confounders, 25(OH)D remained a risk factor for patients with more severe fractures (p = 0.01), particularly those with intertrochanteric fractures (p = 0.011). No significant differences in BTMS were found between patients with less severe and more severe fractures.
Levels of 25(OH)D were significantly associated with the severity of intertrochanteric, but not femoral neck, fractures. Neither 25(OH)D nor BTMs were associated with the type of hip fracture in older women. Separate consideration of intertrochanteric and femoral neck fractures may be appropriate when investigating the clinical association between 25(OH)D and the severity of hip fractures in older women.
维生素 D（25（OH）D）状况和骨转换标志物（BTMs）被认为是骨质量的重要决定因素，骨质量与老年人髋部骨折（包括股骨颈和转子间骨折）的风险相关；然而，25（OH）D 和 BTMs 与髋部骨折的类型和严重程度的确切关系尚不清楚，本研究旨在确定任何特定的关联。
根据纳入和排除标准，纳入了 2015 年至 2020 年间的 441 名患有髋部骨折的老年女性患者和 215 名无髋部骨折的女性，按照股骨颈和转子间骨折的 Garden 和 AO/OTA 分类，将患者分为较轻（Garden I 和 Garden II；31A1）和较重（Garden III 和 Garden IV；31A2 和 31A3）骨折组。分析了血清成骨细胞指标 N 端/中段（N-MID）、破骨细胞指标β-羧基端肽（β-CTX）和 25（OH）D 的水平。
对于较轻的骨折患者，平均 25（OH）D 水平明显高于较重的骨折患者（17.67 与 15.30ng/ml，p=0.006）。较轻的转子间骨折患者的 25（OH）D 水平也较高（p=0.01）。调整混杂因素后，25（OH）D 仍是较重骨折患者的危险因素（p=0.01），尤其是转子间骨折患者（p=0.011）。较轻和较重骨折患者的 BTMs 无显著差异。
25（OH）D 水平与转子间骨折的严重程度显著相关，但与股骨颈骨折无关。在老年女性中，25（OH）D 或 BTMs 与髋部骨折的类型均无关联。在研究老年女性 25（OH）D 与髋部骨折严重程度的临床关联时，单独考虑转子间和股骨颈骨折可能更为合适。
