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Foroni MZ, Cendoroglo MS, Sakane EN, Marin-Mio RV, Moreira PFDP, Maeda SS, Lazaretti-Castro M. Serum 25 hydroxyvitamin D concentrations in individuals over 80 years old and their correlations with musculoskeletal and health parameters. Endocrine 2023; 79:559-570. [PMID: 36305996 DOI: 10.1007/s12020-022-03231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/09/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The present study aims to evaluate the serum concentrations of 25 hydroxyvitamin D[25(OH)D] in individuals aged ≥80 years, independent, free-living in Sao Paulo, Brazil (Lat 23.5 oS), and to investigate their associations with musculoskeletal system, physical performance and health markers. METHOD This cross-sectional study included 212 community dwellers aged ≥80 years and evaluated serum 25(OH)D, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density. Physical performance was evaluated with stationary march, Flamingo, and functional reach tests, questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and Charlson index. Physical activity was evaluated with the International Physical Activity Questionnaire. RESULTS Vitamin D deficiency (<20 ng/mL) was observed in 56% and severe vitamin D deficiency (<10 ng/mL) in 13% of those individuals. Serum concentrations of 25(OH)D were significantly and positively associated with BMD total hip (p = 0.001), femoral neck (p = 0.011) and 33% radius (p = 0.046) BMDs, MET (p = 0.03) and functional reach test (p = 0.037) and negatively with age (p = 0.021), PTH (p = 0.004) and osteoporosis diagnosis (p = 0.012). Long-lived individuals with 25(OH)D ≥ 20 ng/mL had higher total hip and femoral neck BMDs (p = 0.012 and p = 0.014, respectively) and lower PTH (p = 0.030). In multiple linear regression analysis, age and osteoporosis diagnosis remained negatively associated with 25(OH)D levels (p = 0.021 and p = 0.001, respectively), while corrected calcium and cholecalciferol use remained positively associated (p = 0.001 and p = 0.024, respectively). CONCLUSION We observed high vitamin D inadequacy prevalence in those Brazilian community dwellers' oldest old. Serum concentrations of 25(OH)D were positively associated with bone mass and dynamic balance, and negatively with PTH and osteoporosis diagnosis. Additionally, 25(OH)D ≥ 20 ng/mL was associated with better bone mass and lower PTH levels.
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Affiliation(s)
- Mariana Zuccolotto Foroni
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Maysa Seabra Cendoroglo
- Division of Geriatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Eliane Naomi Sakane
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rosangela Villa Marin-Mio
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Sergio Setsuo Maeda
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Arima K, Mizukami S, Nishimura T, Tomita Y, Nakashima H, Abe Y, Aoyagi K. Epidemiology of the association between serum 25-hydroxyvitamin D levels and musculoskeletal conditions among elderly individuals: a literature review. J Physiol Anthropol 2020; 39:38. [PMID: 33243295 PMCID: PMC7690203 DOI: 10.1186/s40101-020-00249-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Vitamin D deficiency is associated with osteoporosis, fracture, muscle weakness, falls, and osteoarthritis in adults. Elderly individuals are more likely to present with poor musculoskeletal conditions. Recently, several epidemiological studies have assessed the correlation between serum 25-hydroxyvitamin D (25(OH)D) levels and musculoskeletal conditions in elderly individuals. Main text Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Numerous studies have shown a positive association between serum 25(OH)D levels and bone mineral density. Only a few studies have reported an association between serum 25(OH)D levels and quantitative ultrasound (QUS) parameters. Low serum 25(OH)D level may be a risk factor for hip fracture. However, data on the association between vitamin D deficiency and the incidence of non-hip fracture are contrasting. Falls are a major cause of mortality and morbidity in older adults. Several prospective population-based cohort studies have shown that low 25(OH)D levels are associated with an increased risk of falls. Reduced muscle strength and physical performance are risk factors for adverse events, including disability, institutionalization, and mortality. The role of vitamin D in musculoskeletal functionality (muscle weakness and physical performance) among elderly individuals is still controversial. Osteoarthritis (OA) is the most common form of arthritis and is a leading cause of disability among older adults. Data on the association between serum 25(OH)D levels and OA are contrasting. Conclusion Some studies have shown that vitamin D deficiency may be a risk factor for poor musculoskeletal conditions, such as osteoporosis, fracture, muscle weakness, falls, and osteoarthritis in adults. However, other studies did not find an association between serum 25(OH)D levels and musculoskeletal conditions.
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Affiliation(s)
- Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Nishimura
- Department of Human Science, Faculty of Design, Kyushu University, Fukuoka, Japan
| | - Yoshihito Tomita
- School of Rehabilitation, Department of Physical Therapy, Tokyo Professional University of Health Sciences, Tokyo, Japan
| | - Hiroki Nakashima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Machado KLLL, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Menezes PR, Pereira RMR. Risk Factors for Low Muscle Mass in a Population-based Prospective Cohort of Brazilian Community-dwelling Older Women: The São Paulo Ageing & Health (SPAH) Study. J Clin Densitom 2020; 23:503-510. [PMID: 31174963 DOI: 10.1016/j.jocd.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women. METHODS A total of 408 women aged ≥65 yr from the São Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005-2007). After a follow-up of 4.3 ± 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM. RESULTS At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 ± 4.9 yr in the LMM group and 72.5 ± 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 ± 5.2 kg/m2 in the LMM group and 28.1 ± 4.7 kg/m2 in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 μUI/L-increase), serum creatinine levels (OR = 11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase). CONCLUSIONS Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention.
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Affiliation(s)
- Ketty L L L Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diogo S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luana G Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jaqueline B Lopes
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valeria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo R Menezes
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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One-legged stance sway of older adults with and without falls. PLoS One 2018; 13:e0203887. [PMID: 30222769 PMCID: PMC6141084 DOI: 10.1371/journal.pone.0203887] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/29/2018] [Indexed: 02/06/2023] Open
Abstract
Postural instability is a common problem among older people, and it is associated with mobility impairments, activity limitation and fear of falling. The evaluation of postural control can contribute to the early detection of balance deficits and help health professionals to manage this problem to prevent falls in older adults. The aim of this study was to identify center of pressure cut-offs to differentiate between older adults with and without falls in the past 12 months. The participants were 170 older adults (mean age 67 years, 50 fallers and 120 non-fallers). Center of pressure area and sway velocity in the anterior-posterior and medio-lateral directions were assessed using a force platform during three 30s one-legged stance trials with eyes open. The mean across trials was used for analysis. The time-limit (how long the participant was able to stay in one-legged stance, up to 30s) was also assessed. Fallers had poorer postural control than non-fallers (effect size ≥ 0.52, P <0.05). The cut-offs identified were 10.3 cm2 for Center of pressure area, 2.9 cm/s for velocity in the anterior-posterior, and 3.4 cm/s for medio-lateral velocity. The force platform parameters obtained an area under the curve of 0.72, with sensitivity of 78% and specificity of 68%. There were no significant differences between non-fallers and fallers for time-limit variable (17 seconds vs. 18 seconds). Force platform parameters during one-legged stance were associated with history of falls in older adults. The cut-offs obtained acceptable area under curve, sensitivity and specificity, with center of pressure area presenting the best performance to differentiate between fallers and non-fallers.
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Rotman-Pikielny P, Frankel M, Lebanon OT, Yaacobi E, Tamar M, Netzer D, Nabriski D, Nyska M, Brin YS. Orthopedic-Metabolic Collaborative Management for Osteoporotic Hip Fracture. Endocr Pract 2018; 24:718-725. [PMID: 30084682 DOI: 10.4158/ep-2018-0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Osteoporotic hip fractures are associated with increased morbidity, mortality, and secondary fractures. Although osteoporosis treatment can reduce future fracture risk, patients often do not receive it. We report results of a coordinator-less fracture liaison service in Israel addressing hip fracture patients. The primary endpoint was attending the Metabolic Clinic. Secondary endpoints included vitamin D measurement, calcium and vitamin D recommendations, initiation of osteoporosis treatment, and mortality 1-year post-fracture. METHODS This prospective study included 219 hip fracture patients who were compared with historical controls. Data on hospitalized patients were collected before and after implementation of a structured protocol for hip fracture patients, led by a multidisciplinary team, without a coordinator. RESULTS The study included 219 and 218 patients ≥60 years old who were operated on in 2013 and 2012, respectively. Metabolic Clinic visits increased from 6.4 to 40.2% after the intervention ( P<.001). Among 14 patients who attended the Clinic in 2012, 85.7% began osteoporosis therapy; among 88 who attended in 2013, 45.5% were treated at the first visit. Vitamin D measurements and calcium and vitamin D supplementation increased postintervention (0.5-80.1%, P<.001; 30.8-84.7%, P<.001, respectively). Patients receiving osteoporosis medications had lower mortality rates than untreated patients (4.3% vs. 21.8%). CONCLUSION An Orthopedic-Metabolic team implemented by existing staff without a coordinator can improve osteoporosis care for hip fracture patients. Yet, gaps remain as only 40% had Metabolic Clinic follow-up postintervention, and of these, only half received specific treatment recommendations. Hospitals are encouraged to adopt secondary fracture prevention protocols and continuously improve them to close the gaps between current management and appropriate metabolic assessment and treatment. ABBREVIATIONS CHS = Clalit Health Services; CI = confidence interval; FLS = fracture liaison service; HMO = health maintenance organization; OR = odds ratio.
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Clock-Drawing Test as a Bedside Assessment of Post-operative Delirium Risk in Elderly Patients with Accidental Hip Fracture. World J Surg 2017; 42:1340-1345. [DOI: 10.1007/s00268-017-4294-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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