Kim Hong Seok, Jang Geun, Park Jung Wee, Lee Young-Kyun, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
J Bone Metab. 2021 Feb;28(1):79-83. doi: 10.11005/jbm.2021.28.1.79. Epub 2021 Feb 28.
Vitamin D plays a critical role in the proliferation and differentiation of skeletal muscle and bone metabolism. We compared the prevalence of vitamin D deficiency in elderly patients undergoing hip fracture surgery (HFS) with those undergoing elective primary total hip arthroplasty (THA). We also evaluated the association between vitamin D deficiency and sarcopenia.
This prospective study included 70 patients in the HFS group, and 100 patients in the elective THA group. The HFS group included 42 women, while the elective THA group included 74 women. The mean age in the HFS and elective THA groups was 79.8 and 75.4 years, respectively, and the mean preoperative Koval score was 2.1 and 2.3, respectively. Serum 25-hydroxy-vitamin D3 levels were measured by I125 radioimmunoassay. Bone mineral density and appendicular skeletal muscle mass (ASM) were measured using dual X-ray absorptiometry. Sarcopenia index was calculated by dividing ASM (kg) by the body mass index (kg/m2). Sarcopenia was diagnosed when the sarcopenia index was <0.789 in men and <0.512 in women.
Serum vitamin D levels were lower, and the percentages of patients with vitamin D insufficiency and deficiency were higher in the HFS group than in the elective THA group. In the HFS group, the prevalence of sarcopenia was higher in men (57%, 16/28) than in women (29%, 12/42; P=0.025).
Vitamin D deficiency was more prevalent in patients undergoing HFS than in patients undergoing elective THA. Among patients undergoing HFS, vitamin D deficiency was more prevalent in sarcopenic than in non-sarcopenic patients.
维生素D在骨骼肌的增殖与分化以及骨代谢中起着关键作用。我们比较了接受髋部骨折手术（HFS）的老年患者与接受择期初次全髋关节置换术（THA）的老年患者维生素D缺乏症的患病率。我们还评估了维生素D缺乏与肌肉减少症之间的关联。
这项前瞻性研究包括70例HFS组患者和100例择期THA组患者。HFS组包括42名女性，而择期THA组包括74名女性。HFS组和择期THA组的平均年龄分别为79.8岁和75.4岁，术前平均Koval评分分别为2.1和2.3。采用I125放射免疫分析法测定血清25-羟基维生素D3水平。使用双能X线吸收法测量骨密度和四肢骨骼肌质量（ASM）。肌肉减少症指数通过将ASM（kg）除以体重指数（kg/m2）来计算。当男性肌肉减少症指数<0.789且女性<0.512时，诊断为肌肉减少症。
HFS组的血清维生素D水平较低，维生素D不足和缺乏患者的百分比高于择期THA组。在HFS组中，男性肌肉减少症的患病率（57%，16/28）高于女性（29%，12/42；P=0.025）。
接受HFS的患者比接受择期THA的患者维生素D缺乏更为普遍。在接受HFS的患者中，肌肉减少症患者的维生素D缺乏比非肌肉减少症患者更为普遍。
