Komar L, Nieves J, Cosman F, Rubin A, Shen V, Lindsay R
Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY 10993-1195.
J Am Geriatr Soc. 1993 Oct;41(10):1057-64. doi: 10.1111/j.1532-5415.1993.tb06452.x.
To evaluate the skeletal health, calcium, and vitamin D homeostasis of patients upon their entry to a long-term-care facility. Factors that could contribute to the risk of future osteoporotic fractures were also evaluated.
Cross-sectional study.
Two hundred eighty-seven consecutive admissions were invited to participate; 109 patients were recruited into the study.
A high prevalence of low to low-normal circulating levels of 25(OH)D was found in nursing home residents upon their admission to the nursing home, with 86% of the patients having circulating 25(OH)D levels of less than 50 nmol/L and 41% having levels below 25 nmol/L. Frankly elevated parathyroid hormone levels were found in 16% of the patients. Additionally, alkaline phosphatase and osteocalcin levels were elevated in 23% and 13% of the patients, respectively. Bone mineral measurements were in the osteoporotic range for 85% of the nursing home residents. Bone density results for females with a history of any classic osteoporotic fracture were significantly lower than for those with no fracture history (68.5 arbitrary units (AU) for those with no fracture history, 58.8 AU in those with history of hip fracture; P < 0.05). The bone mineral measurements were higher in women with adequate 25(OH)D compared with women with deficient or borderline 25(OH)D with and without fracture history. Levels of 25(OH)D were positively correlated with urine calcium/creatinine (r = .24; P = 0.03) and 1,25(OH)2D (r = .28; P = 0.01) and were negatively correlated with 1-84 PTH (r = -.24; P = 0.02).
Hypovitaminosis D is prevalent among elderly patients entering a nursing home with secondary hyperparathyroidism and apparently increased bone turnover present in patients with circulating 25(OH)D levels below 50 nmol/L. Bone density measurements showed that a majority of the individuals entering a nursing home are osteoporotic. There is a positive association between 25(OH)D levels and bone mass and a negative association between 25(OH)D levels and a history of fracture.
评估进入长期护理机构的患者的骨骼健康、钙和维生素D稳态。还评估了可能导致未来骨质疏松性骨折风险的因素。
横断面研究。
邀请了287名连续入院患者参与；109名患者被纳入研究。
发现养老院居民入院时循环25(OH)D水平处于低至低正常范围的比例很高，86%的患者循环25(OH)D水平低于50 nmol/L，41%的患者水平低于25 nmol/L。16%的患者甲状旁腺激素水平明显升高。此外，23%和13%的患者碱性磷酸酶和骨钙素水平分别升高。85%的养老院居民骨矿物质测量结果处于骨质疏松范围内。有任何典型骨质疏松性骨折病史的女性的骨密度结果显著低于无骨折病史的女性（无骨折病史者为68.5任意单位(AU)，有髋部骨折病史者为58.8 AU；P<0.05）。与25(OH)D缺乏或临界的有和无骨折病史的女性相比，25(OH)D充足的女性骨矿物质测量值更高。25(OH)D水平与尿钙/肌酐(r = 0.24；P = 0.03)和1,25(OH)2D(r = 0.28；P = 0.01)呈正相关，与1-84 PTH(r = -0.24；P = 0.02)呈负相关。
维生素D缺乏症在进入养老院的老年患者中普遍存在，伴有继发性甲状旁腺功能亢进，且循环25(OH)D水平低于50 nmol/L 的患者骨转换明显增加。骨密度测量显示，大多数进入养老院的个体患有骨质疏松症。25(OH)D水平与骨量呈正相关，与骨折病史呈负相关。
