Chen Xi, Shen Li, Gao Chao, Weng Rou, Fan Yier, Xu Shuqin, Zhang Zhenlin, Hu Weiwei
Department of Osteoporosis and Bone Disease, Shanghai Clinical Research Center of Bone Disease, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clinical Research Center, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Nutr. 2024 Jan 10;10:1307896. doi: 10.3389/fnut.2023.1307896. eCollection 2023.
Vitamin D is a key factor in bone metabolism, yet vitamin D insufficiency and deficiency are prevalent among postmenopausal women, with potential repercussions on bone mineral density (BMD), bone turnover markers (BTMs), and parathyroid hormone (PTH). Nonetheless, the findings from existing studies exhibit inconsistency, and a notable gap exists in the availability of large-scale investigations.
In this real-world study, 8,532 postmenopausal women over 50 years old with a diagnosis of osteopenia (50.9%) and osteoporosis (49.1%) at the first visit were enrolled in this study. Serum 25(OH)D level, PTH, osteocalcin (OC) and Beta-CrossLaps of type 1 collagen containing cross-linked C-telopeptide (β-CTX), were measured. BMD at all sites, including the lumbar spine, femoral neck, and total hip were obtained by dual-energy X-ray absorptiometry (DXA). The associations of serum 25(OH)D level with BMDs and BTMs were investigated using spearman correlation analysis and analysis of general linear model adjusted by age and body mass index.
The serum 25(OH)D level was 22.17 ± 9.75 ng/mL among all patients included in this study. For the osteopenia group, the serum 25(OH)D level was 22.40 ± 9.41 ng/mL, while for the osteoporosis group, it measured 21.93 ± 10.08 ng/mL. In the osteopenia group, the prevalence of vitamin D deficiency, insufficiency and sufficiency was 45.8, 34.6, and 19.6%, respectively, which was close to that of the osteoporosis group (47.4, 34.3, and 18.3%) ( = 0.202). Spearman correlation analysis unveiled negative associations between serum 25(OH)D concentrations and both BTMs and PTH within both the osteopenia and osteoporosis group. In the osteoporosis group, there were positive correlations between 25(OH)D levels and femoral neck BMD ( = 0.040, = 0.010) and total hip BMD ( = 0.053, = 0.001). Furthermore, we found that for the osteopenia group, greater vitamin D levels were associated with greater femoral neck BMD ( = 0.020) and total hip BMD ( = 0.008) and lower β-CTX ( < 0.001), OC ( < 0.001), and PTH ( < 0.001). The same trends were seen in osteoporosis patients ( < 0.05), and with greater lumbar spine BMD with higher levels of 25(OH)D ( = 0.009).
This study showed high prevalence of vitamin D deficiency and insufficiency in Chinese postmenopausal women with osteopenia and osteoporosis and the relationships between vitamin D and BMD, BTMs and PTH. The results contribute to a more comprehensive understanding of how vitamin D may impact bone health.
维生素D是骨代谢的关键因素，但维生素D不足和缺乏在绝经后女性中普遍存在，这可能对骨密度（BMD）、骨转换标志物（BTMs）和甲状旁腺激素（PTH）产生潜在影响。尽管如此，现有研究结果并不一致，且大规模调查的资料存在显著缺口。
在这项真实世界研究中，纳入了8532例50岁以上首次就诊诊断为骨质减少（50.9%）和骨质疏松（49.1%）的绝经后女性。检测血清25（OH）D水平、PTH、骨钙素（OC）和1型胶原交联C末端肽（β-CTX）。通过双能X线吸收法（DXA）测量包括腰椎、股骨颈和全髋在内所有部位的骨密度。采用Spearman相关分析以及经年龄和体重指数校正的一般线性模型分析，研究血清25（OH）D水平与骨密度和骨转换标志物之间的关联。
本研究纳入的所有患者血清25（OH）D水平为22.17±9.75 ng/mL。骨质减少组血清25（OH）D水平为22.40±9.41 ng/mL，骨质疏松组为21.93±10.08 ng/mL。骨质减少组维生素D缺乏、不足和充足的患病率分别为45.8%、34.6%和19.6%，与骨质疏松组（47.4%、34.3%和1）接近（=0.202）。Spearman相关分析显示，在骨质减少组和骨质疏松组中，血清25（OH）D浓度与骨转换标志物和PTH均呈负相关。在骨质疏松组中，25（OH）D水平与股骨颈骨密度（=0.040，=0.）和全髋骨密度（=0.053，=0.）呈正相关。此外，我们发现，对于骨质减少组，较高的维生素D水平与较高的股骨颈骨密度（=0.020）和全髋骨密度（=0.008）以及较低的β-CTX（<0.001）、OC（<0.001）和PTH（<0.001）相关。骨质疏松患者也呈现相同趋势（<0.05），且25（OH）D水平越高，腰椎骨密度越高（=0.009）。
本研究表明，中国绝经后骨质减少和骨质疏松女性中维生素D缺乏和不足的患病率较高，且揭示了维生素D与骨密度、骨转换标志物和PTH之间的关系。这些结果有助于更全面地了解维生素D对骨骼健康的影响。
