Fardellone P, Sebert J L, Garabedian M, Bellony R, Maamer M, Agbomson F, Brazier M
Department of Rheumatology, North Hospital, Amiens, France.
Rev Rhum Engl Ed. 1995 Oct;62(9):576-81.
The prevalence of vitamin D deficiency was evaluated in a population of elderly institutionalized subjects in seven long-term geriatric care facilities in France (Amiens, Francheville, Ivry, Lille, Montpellier, Oissel and Villejuif). Residents whose functional capability was relatively good were entered into the study. There were 126 patients (99 females and 27 males) with a mean age +/- SD of 84 +/- 6.6 years. All subjects had been institutionalized for over six months and were capable of walking at least as far as the dining room. None had received vitamin D or other compounds known to affect the metabolism of phosphorus and calcium within six months before the study. Vitamin D status was evaluated by determining serum 25 hydroxyvitamin D (25 OH D) levels using a radiocompetition assay after extraction and chromatographic separation. Mean serum 25 OH D was 3.17 +/- 2.52 ng/ml (median 2.5). Eighty-five per cent of subjects had serum 25 OH D values of less than 5 ng/ml and 98% had values under 10 ng/ml, which is the cutoff usually taken to define vitamin D deficiency. Mean serum levels of intact parathyroid hormone were increased approximately two-fold as compared with values in healthy adults (70 +/- 39 pg/ml versus 33 +/- 12 pg/ml). Biochemical markers for bone formation (alkaline phosphatase, osteocalcin) and bone resorption (TRAP, hydroxyproline, pyridinoline) were all increased, with mean values 1.4-fold to 3.4-fold those seen in healthy adults. Serum 25 OH D levels were negatively correlated with serum intact parathyroid hormone levels (r = 0.41; p < 0.0001). Serum intact parathyroid hormone levels were positively correlated with alkaline phosphatase activity (r = 0.30; p < 0.001) and serum osteocalcin levels (r = 0.36; p < 0.0001) and negatively correlated with corrected serum calcium levels (r = -0.20; p < 0.02). Conclusion. Our data demonstrate that severe vitamin D deficiency is present in virtually all elderly institutionalized subjects and is accompanied with secondary hyperparathyroidism responsible for increases in markers of bone remodeling. Routine vitamin D supplementation is warranted in elderly institutionalized subjects.
在法国的七个长期老年护理机构（亚眠、弗朗什维尔、伊夫里、里尔、蒙彼利埃、瓦塞尔和维勒瑞夫）中，对一群老年住院患者的维生素D缺乏患病率进行了评估。功能能力相对较好的居民被纳入研究。共有126名患者（99名女性和27名男性），平均年龄±标准差为84±6.6岁。所有受试者均已住院超过六个月，并且能够至少走到餐厅。在研究前六个月内，没有人接受过维生素D或其他已知会影响磷和钙代谢的化合物。维生素D状态通过在提取和色谱分离后使用放射竞争分析法测定血清25-羟基维生素D（25-OH D）水平来评估。血清25-OH D的平均值为3.17±2.52 ng/ml（中位数为2.5）。85%的受试者血清25-OH D值低于5 ng/ml，98%的值低于10 ng/ml，这是通常用于定义维生素D缺乏的临界值。与健康成年人相比，完整甲状旁腺激素的平均血清水平大约增加了两倍（70±39 pg/ml对33±12 pg/ml）。骨形成（碱性磷酸酶、骨钙素）和骨吸收（抗酒石酸酸性磷酸酶、羟脯氨酸、吡啶啉）的生化标志物均升高，其平均值是健康成年人的1.4倍至3.4倍。血清25-OH D水平与血清完整甲状旁腺激素水平呈负相关（r = 0.41；p < 0.0001）。血清完整甲状旁腺激素水平与碱性磷酸酶活性呈正相关（r = 0.30；p < 0.001），与血清骨钙素水平呈正相关（r = 0.36；p < 0.0001），与校正后的血清钙水平呈负相关（r = -0.20；p < 0.02）。结论。我们的数据表明，几乎所有老年住院患者都存在严重的维生素D缺乏，并伴有继发性甲状旁腺功能亢进，导致骨重塑标志物增加。老年住院患者有必要进行常规维生素D补充。
