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Doumit M, El-Mallah C, El-Makkawi A, Obeid O, Kobeissy F, Darwish H, Abou-Kheir W. Vitamin D Deficiency Does Not Affect Cognition and Neurogenesis in Adult C57Bl/6 Mice. Nutrients 2024; 16:2938. [PMID: 39275253 PMCID: PMC11396937 DOI: 10.3390/nu16172938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/21/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Vitamin D deficiency is a global problem. Vitamin D, the vitamin D receptor, and its enzymes are found throughout neuronal, ependymal, and glial cells in the brain and are implicated in certain processes and mechanisms in the brain. To investigate the processes affected by vitamin D deficiency in adults, we studied vitamin D deficient, control, and supplemented diets over 6 weeks in male and female C57Bl/6 mice. The effect of the vitamin D diets on proliferation in the neurogenic niches, changes in glial cells, as well as on memory, locomotion, and anxiety-like behavior, was investigated. Six weeks on a deficient diet was adequate time to reach deficiency. However, vitamin D deficiency and supplementation did not affect proliferation, neurogenesis, or astrocyte changes, and this was reflected on behavioral measures. Supplementation only affected microglia in the dentate gyrus of female mice. Indicating that vitamin D deficiency and supplementation do not affect these processes over a 6-week period.
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Affiliation(s)
- Mark Doumit
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Carla El-Mallah
- Department of Nutrition and Food Science, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Alaa El-Makkawi
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Omar Obeid
- Department of Nutrition and Food Science, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Hala Darwish
- Hariri School of Nursing, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
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Cianferotti L, Bifolco G, Caffarelli C, Mazziotti G, Migliaccio S, Napoli N, Ruggiero C, Cipriani C. Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review. Nutrients 2024; 16:1773. [PMID: 38892706 PMCID: PMC11174536 DOI: 10.3390/nu16111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Hip fractures are a major health issue considerably impacting patients' quality of life and well-being. This is particularly evident in elderly subjects, in which the decline in bone and muscle mass coexists and predisposes individuals to fall and fracture. Among interventions to be implemented in hip fractured patients, the assessment and management of nutritional status is pivotal, particularly in subjects older than 65. Nutrition plays a central role in both primary and secondary preventions of fracture. An adequate protein intake improves muscle mass and strength and the intestinal absorption of calcium. Other nutrients with recognized beneficial effects on bone health are calcium, vitamins D, K, and C, potassium, magnesium, folate, and carotenoids. With reference to calcium, results from longitudinal studies showed that the consumption of dairy foods has a protective role against fractures. Moreover, the most recent systematic reviews and meta-analyses and one umbrella review demonstrated that the combination of calcium and vitamin D supplementation significantly reduces hip fracture risk, with presumed higher efficacy in older and institutionalized subjects. Owing to these reasons, the adequate intake of calcium, vitamin D, protein, and other macro and micronutrients has been successfully implemented in the Fracture Liaison Services (FLSs) that represent the most reliable model of management for hip fracture patients. In this narrative review, papers (randomized controlled trials, prospective and intervention studies, and systematic reviews) retrieved by records from three different databases (PubMed, Embase, and Medline) have been analyzed, and the available information on the screening, assessment, and management of nutritional and vitamin D status and calcium intake in patients with hip fractures is presented along with specific prevention and treatment measures.
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Affiliation(s)
- Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, 50134 Florence, Italy;
| | - Giuseppe Bifolco
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, 50134 Florence, Italy;
| | - Carla Caffarelli
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Silvia Migliaccio
- Department of Experimental Medicine, University Sapienza of Rome, 00185 Rome, Italy;
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Rome Biomedical Campus University Foundation, 00128 Rome, Italy;
| | - Carmelinda Ruggiero
- Geriatric and Orthogeriatric Units, Division Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy;
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
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Byun SE, Kim H, Lee SY, Kim SM. Selective estrogen receptor modulators (SERMs) with vitamin D composite agent can prevent fracture better than SERMs treatment: based on the National Health Claims Database 2017-2019. Osteoporos Int 2024; 35:775-783. [PMID: 38240755 DOI: 10.1007/s00198-024-07022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/11/2024] [Indexed: 04/20/2024]
Abstract
With the analysis of nationwide health claim data, treatment with the composite agent of SERMs and vitamin D reduces the risk of osteoporotic fracture and hip fracture better compared to SERMs treatment in women with osteoporosis aged ≥ 50 years. PURPOSE This study compared the potential of the composite agent of selective estrogen receptor modulators (SERMs) and vitamin D (SERM + VitD) with that of SERMs-only for fracture prevention and mortality reduction in women aged ≥ 50 years. METHODS The incidence of osteoporotic fracture (fractures of the vertebrae, hip, wrist, or humerus) and all-cause death after treatment with SERM + VitD and SERMs were characterized using the Korean National Health Insurance Service database 2017-2019. The participants were divided into two groups (SERM + VitD vs SERMs). After exclusion and propensity score matching, 2,885 patients from each group were included in the analysis. Fracture incidence was compared between groups. Kaplan-Meier curves were used to compare mortality. Cox proportional hazards regression analysis was used to compare the risks of fracture occurrence and mortality between the groups. RESULTS The incidence rate (138.6/10,000 vs. 192.4/10,000 person-years), and risk of osteoporotic fractures (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.97; p = 0.024) were lower in the SERM + VitD group than in the SERMs group. Analysis for specific fractures showed a lower hazard of hip fracture in the SERM + VitD group (HR, 0.25; 95% CI, 0.09-0.71; p = 0.009). No difference was observed between the groups regarding mortality. CONCLUSION The risk of osteoporotic fractures, especially hip fractures, was lower in the SERM + VitD group than in the SERMs group. Therefore, the composite agent of SERMs and vitamin D can be considered as a viable option for postmenopausal women with a relatively low fracture risk.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Republic of Korea
| | - Hasung Kim
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Seung Yun Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Sang-Min Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 02841, Republic of Korea.
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Capdevila-Reniu A, Navarro-López M, Sapena V, Jordan AI, Arroyo-Huidobro M, López-Soto A. Predictive factors of osteoporotic hip fracture in octogenarians. Rev Clin Esp 2024; 224:77-85. [PMID: 38237859 DOI: 10.1016/j.rceng.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. MATERIAL AND METHODS We conducted a case-control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). RESULTS Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (p < 0.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The Nutritional state (OR: 0.08 [0.01-0.61]), the folic acid levels (OR 0.32 [0.1-1]), and a loss of visual acuity (OR 33.16 [2.91-377.87]) were the independent risk factors associated with hip fracture. CONCLUSIONS The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures.
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Affiliation(s)
- A Capdevila-Reniu
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - M Navarro-López
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - V Sapena
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain; Biostatistics Unit, Medical School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A I Jordan
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Arroyo-Huidobro
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - A López-Soto
- Orthogeriatric Unit, Department of Internal Medicine, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Heinly B, Allenzara A, Helm M, Foulke GT. Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations. Drugs Aging 2024; 41:31-43. [PMID: 37991658 DOI: 10.1007/s40266-023-01079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
Though more common earlier in life, increasing attention is being focused on the development of cutaneous lupus erythematosus (CLE) in patients with advancing age. Studies show that CLE is more common in older populations than previously thought, and all CLE subtypes are possible in this group. Just like patients in the third or fourth decade of life, CLE may appear alongside or independent of systemic lupus erythematosus. Older populations manifesting CLE for the first time seem to have a lower risk of progression to systemic disease than younger peers, and are more commonly White. CLE must be carefully distinguished from other skin conditions that have a predilection for presentation in older populations, including rosacea, lichen planus, and other autoimmune conditions such as dermatomyositis or pemphigus/pemphigoid. It is thought that most CLE in older populations is drug-induced, with drug-induced subacute cutaneous lupus erythematosus being the most common subtype. Management of CLE in older patients focuses on eliminating unnecessary medications known to induce CLE, and otherwise treatment proceeds similarly to that in younger patients, with a few special considerations.
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Affiliation(s)
| | - Astia Allenzara
- Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Yoshida S, Shiraishi R, Nakayama Y, Taira Y. Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society? Nutrients 2023; 15:2991. [PMID: 37447315 DOI: 10.3390/nu15132991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become pertinent problems. The prevalence of comorbidities is a major problem in countries with aged populations as elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. All of these diseases are associated with sarcopenia and frailty, and they frequently cause falls, fractures, and a decline in activities of daily living. Fractures in the elderly people are associated with bone fragility, which is influenced by diabetes and chronic kidney disease. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood glucose level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solve the health-related problems in super-aging societies.
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Affiliation(s)
- Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
- Department of Health and Nutrition, Okinawa University, 555 Kokuba, Naha 902-8521, Okinawa, Japan
- Faculty of Health Sciences, Kinjo University, 1200 Kasama-machi, Hakusan 924-8511, Ishikawa, Japan
| | - Ryo Shiraishi
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yuki Nakayama
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yasuko Taira
- Faculty of Nutrition, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
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Struppe A, Schanda JE, Baierl A, Watzl P, Muschitz C. Impact of Intravenous Iron Substitution on Serum Phosphate Levels and Bone Turnover Markers-An Open-Label Pilot Study. Nutrients 2023; 15:2693. [PMID: 37375595 DOI: 10.3390/nu15122693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The association between intravenous iron substitution therapy and hypophosphatemia was previously reported in patients with iron deficiency anemia. However, the extent of hypophosphatemia is thought to depend on the type of iron supplementation. We hypothesized that the intravenous application of ferric carboxymaltose and iron sucrose leads to a different longitudinal adaptation in serum phosphate levels. In this open-label pilot study, a total of 20 patients with inflammatory bowel diseases or iron deficiency anemia were randomly assigned to one of two study groups (group 1: ferric carboxymaltose, n = 10; group 2: iron sucrose, n = 10). Serum values were controlled before iron substitution therapy, as well as 2, 4, and 12 weeks after the last drug administration. The primary objective of the study was the longitudinal evaluation of serum phosphate levels after iron substitution therapy with ferric carboxymaltose and iron sucrose. The secondary objective was the longitudinal investigation of calcium, 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone, procollagen type 1 amino-terminal propeptide (P1NP), beta-CrossLaps (CTX), hemoglobin (Hb), iron, ferritin, and transferrin saturation levels. Two weeks after drug administration, phosphate levels were significantly lower (p < 0.001) in group 1 and ferritin levels were significantly higher (p < 0.001) in group 1. Phosphate levels (0.8-1.45 mmol/L) were below the therapeutic threshold and ferritin levels (10-200 ng/mL for women and 30-300 ng/mL for men) were above the therapeutic threshold in group 1. P1NP (15-59 µg/L) and CTX (<0.57 ng/mL) levels were above the therapeutic threshold in group 2. Four weeks after drug administration, significant differences were still observed between both study groups for phosphate (p = 0.043) and ferritin (p = 0.0009). All serum values except for Hb were within the therapeutic thresholds. Twelve weeks after drug administration, no differences were observed in all serum values between both study groups. Hb values were within the therapeutic threshold in both study groups. Serum 25(OH)D levels did not differ between both study groups throughout the whole study period and remained within the therapeutic threshold.
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Affiliation(s)
- Alexandra Struppe
- St. Vincent Hospital Vienna, II Medical Department-Gastroenterology, Hepatology, Metabolic, and Inflammation Medicine, Academic Teaching Hospital of the Medical University of Vienna, 1060 Vienna, Austria
| | - Jakob E Schanda
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, 1120 Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology, 1200 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Andreas Baierl
- Insitute for Statistics and Operations Research, University of Vienna, 1090 Vienna, Austria
| | - Paul Watzl
- St. Vincent Hospital Vienna, II Medical Department-Gastroenterology, Hepatology, Metabolic, and Inflammation Medicine, Academic Teaching Hospital of the Medical University of Vienna, 1060 Vienna, Austria
| | - Christian Muschitz
- St. Vincent Hospital Vienna, II Medical Department-Gastroenterology, Hepatology, Metabolic, and Inflammation Medicine, Academic Teaching Hospital of the Medical University of Vienna, 1060 Vienna, Austria
- HealthPi Medical Center, 1010 Vienna, Austria
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Donati S, Marini F, Giusti F, Palmini G, Aurilia C, Falsetti I, Iantomasi T, Brandi ML. Calcifediol: Why, When, How Much? Pharmaceuticals (Basel) 2023; 16:ph16050637. [PMID: 37242420 DOI: 10.3390/ph16050637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Vitamin D deficiency is a constantly growing health problem worldwide. Adults affected with hypovitaminosis D could experience negative consequences on their musculoskeletal system and extra-skeletal health. In fact, an optimal vitamin D status is essential to ensure the correct bone, calcium, and phosphate homeostasis. To improve vitamin D status, it is important to not only increase the intake of food fortified with vitamin D, but also to administer vitamin D supplementation when required. Vitamin D3 (cholecalciferol) is the most widely used supplement. In recent years, the administration of calcifediol (25(OH)D3), the direct precursor of the biologically active form of vitamin D3, as oral vitamin D supplementation has progressively grown. Here, we report the potential medical benefits of some peculiar biological actions of calcifediol, discussing the possible specific clinical scenarios in which the oral intake of calcifediol could be most effective to restore the correct serum levels of 25(OH)D3. In summary, the aim of this review is to provide insights into calcifediol-related rapid non-genomic responses and the possible use of this vitamin D metabolite as a supplement for the treatment of people with a higher risk of hypovitaminosis D.
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Affiliation(s)
- Simone Donati
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Francesca Marini
- Fondazione Italiana Ricerca Sulle Malattie dell'Osso (FIRMO Onlus), 50129 Florence, Italy
| | - Francesca Giusti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Gaia Palmini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Cinzia Aurilia
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Irene Falsetti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Teresa Iantomasi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca Sulle Malattie dell'Osso (FIRMO Onlus), 50129 Florence, Italy
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Ansari H, Jaglal S, Cheung AM, Kurdyak P. Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada. JAMA Netw Open 2023; 6:e2310550. [PMID: 37115547 PMCID: PMC10148203 DOI: 10.1001/jamanetworkopen.2023.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance Evidence suggests that individuals with schizophrenia are at an increased risk of hip fractures; however, the sex-specific burden of hip fractures among adults with schizophrenia has not been quantified and compared with the general population. Objective To describe sociodemographic and clinical characteristics of patients with hip fracture and schizophrenia and to quantify their sex-specific annual hip fracture rates relative to those without schizophrenia. Design, Setting, and Participants This repeated population-based, cross-sectional study leveraged multiple individually linked health administrative databases for patients in Ontario, Canada. We included patients aged 40 to 105 years with hip fracture-related hospitalization between April 1, 2009, and March 31, 2019. Statistical analysis was performed between November 2021 and February 2023. Exposure Schizophrenia diagnosis, ascertained using a validated algorithm. Main Outcomes and Measures The main outcome was sex-specific age-standardized annual hip fracture rate per 10 000 individuals and annual percent change in age-standardized rates. Rates were direct adjusted to the 2011 Ontario population, and joinpoint regression analysis was performed to evaluate annual percent change. Results We identified 117 431 hip fracture records; of these, there were 109 908 index events. Among the 109 908 patients with hip fracture, 4251 had schizophrenia and 105 657 did not. Their median age was 83 years (IQR, 75-89 years), and 34 500 (31.4%) were men. Patients with hip fracture and schizophrenia were younger at the index event compared with those without schizophrenia. Men had a median age of 73 vs 81 years (IQR, 62-83 vs 71-87 years; standardized difference, 0.46), and women had a median age of 80 vs 84 years (IQR, 71-87 vs 77-89 years; standardized difference, 0.32). A higher proportion of patients with vs without schizophrenia had frailty (53.7% vs 34.2%; standardized difference, 0.40) and previous fragility fractures (23.5% vs 19.1%; standardized difference, 0.11). The overall age-standardized rate per 10 000 individuals with vs without schizophrenia was 37.5 (95% CI, 36.4 to 38.6) vs 16.0 (95% CI, 15.9 to 16.1). Age-standardized rates were 3-fold higher in men with vs without schizophrenia (31.0 [95% CI, 29.5 to 32.6] vs 10.1 [95% CI, 10.0 to 10.2]) and more than 2-fold higher in women with vs without schizophrenia (43.4 [95% CI, 41.9 to 44.9] vs 21.4 [95% CI, 21.3 to 21.6]). Overall, joinpoint regression analysis identified a steady annual decrease of 0.7% (95% CI, -1.1% to -0.3%) in age-standardized rates for both study groups. Conclusions and Relevance The findings of this cross-sectional study suggest that individuals with schizophrenia experience an earlier age of onset and considerably higher rate of hip fractures compared with the general population, with implications for targeted fracture prevention and optimization of clinical bone health management over the course of their psychiatric illness.
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Affiliation(s)
- Hina Ansari
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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10
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Waterhouse M, Ebeling PR, McLeod DSA, English D, Romero BD, Baxter C, Armstrong BK, Hartel G, Kimlin M, O'Connell RL, van der Pols JC, Venn AJ, Webb PM, Whiteman DC, Neale RE. The effect of monthly vitamin D supplementation on fractures: a tertiary outcome from the population-based, double-blind, randomised, placebo-controlled D-Health trial. Lancet Diabetes Endocrinol 2023; 11:324-332. [PMID: 37011645 DOI: 10.1016/s2213-8587(23)00063-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Low serum 25-hydroxy vitamin D concentration is associated with increased fracture risk. It is uncertain whether vitamin D supplementation reduces fractures, or whether intermittent doses are harmful. We aimed to investigate if supplementing adults living in Australia with monthly doses of 60 000 international units (IU) vitamin D3 for 5 years or less altered the rate of fractures. METHODS We did a population-based, double-blind, randomised, placebo-controlled trial of oral vitamin D3 supplementation (60 000 IU per month) for up to 5 years in adults aged 60-84 years living in Australia. We randomly assigned (1:1) 21 315 participants to either vitamin D or placebo. We ascertained fractures through linkage with administrative datasets. The main outcome was total fractures. Additional outcomes were non-vertebral, major osteoporotic (hip, wrist, proximal humerus, and spine), and hip fractures. We excluded participants (989 [4·6%]) without linked data, and estimated hazard ratios (HRs) and 95% CIs using flexible parametric survival models. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000743763, and the trial intervention ended in February, 2020. FINDINGS Between Feb 14, 2014, and June 17, 2015, we recruited 21 315 participants. For the current analysis, we included 20 326 participants (vitamin D 10 154 [50·0%]; placebo 10 172 [50·0%]). 9295 (45·7%) of 20 326 participants were women and the mean age was 69·3 years (SD 5·5). Over a median follow-up of 5·1 years (IQR 5·1-5·1), 568 (5·6%) participants in the vitamin D group and 603 (5·9%) in the placebo group had one or more fractures. There was no effect on fracture risk overall (HR 0·94 [95% CI 0·84-1·06]), and the interaction between randomisation group and time was not significant (p=0·14). However, the HR for total fractures appeared to decrease with increasing follow-up time. The overall HRs for non-vertebral, major osteoporotic, and hip fractures were 0·96 (95% CI 0·85-1·08), 1·00 (0·85-1·18), and 1·11 (0·86-1·45), respectively. INTERPRETATION These findings do not support concerns that bolus doses of vitamin D administered monthly increase fracture risk. Long-term supplementation might reduce the incidence of total fractures, but additional research is needed to clarify this effect. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Mary Waterhouse
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Donald S A McLeod
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Dallas English
- Melbourne School of Population Health, University of Melbourne, Melbourne, VIC, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Briony Duarte Romero
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Catherine Baxter
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Bruce K Armstrong
- School of Public Health, University of Sydney, Sydney, NSW, Australia; School of Global and Population Health, University of Western Australia, Perth, WA, Australia
| | - Gunter Hartel
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Michael Kimlin
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rachel L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - David C Whiteman
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rachel E Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia.
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11
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Alonso N, Zelzer S, Eibinger G, Herrmann M. Vitamin D Metabolites: Analytical Challenges and Clinical Relevance. Calcif Tissue Int 2023; 112:158-177. [PMID: 35238975 PMCID: PMC8892115 DOI: 10.1007/s00223-022-00961-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/16/2022] [Indexed: 01/25/2023]
Abstract
Recent research activities have provided new insights in vitamin D metabolism in various conditions. Furthermore, substantial progress has been made in the analysis of vitamin D metabolites and related biomarkers, such as vitamin D binding protein. Liquid chromatography tandem mass spectrometric (LC-MS/MS) methods are capable of accurately measuring multiple vitamin D metabolites in parallel. Nevertheless, only 25(OH)D and the biologically active form 1,25(OH)2D are routinely measured in clinical practice. While 25(OH)D remains the analyte of choice for the diagnosis of vitamin D deficiency, 1,25(OH)2D is only recommended in a few conditions with a dysregulated D metabolism. 24,25(OH)2D, free and bioavailable 25(OH)D, and the vitamin D metabolite ratio (VMR) have shown promising results, but technical pitfalls in their quantification, limited clinical data and the lack of reference values, impede their use in clinical practice. LC-MS/MS is the preferred method for the measurement of all vitamin D related analytes as it offers high sensitivity and specificity. In particular, 25(OH)D and 24,25(OH)2D can accurately be measured with this technology. When interpreted together, they seem to provide a functional measure of vitamin D metabolism beyond the analysis of 25(OH)D alone. The determination of VDBP, free and bioavailable 25(OH)D is compromised by unresolved analytical issues, lacking reference intervals and insufficient clinical data. Therefore, future research activities should focus on analytical standardization and exploration of their clinical value. This review provides an overview on established and new vitamin D related biomarkers including their pathophysiological role, preanalytical and analytical aspects, expected values, indications and influencing conditions.
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Affiliation(s)
- N Alonso
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - S Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - G Eibinger
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - M Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
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12
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Anagnostis P, Livadas S, Goulis DG, Rees M, Lambrinoudaki I. Vitamin D, Menopausal Health and COVID-19: Critical Appraisal of Current Data. J Clin Med 2023; 12:jcm12030916. [PMID: 36769563 PMCID: PMC9917790 DOI: 10.3390/jcm12030916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Inconsistency exists across studies conducted in postmenopausal women regarding the effect of vitamin D deficiency (VDD) and supplementation on several aspects of menopausal health, such as fractures, vasomotor symptomatology, cardiovascular disease (CVD), cancer and infections, including coronavirus disease 2019 (COVID-19). The aim of this review is to critically summarize the evidence provided by observational studies and randomized controlled trials (RCTs) of vitamin D supplementation in postmenopausal women with VDD. Observational studies have found that VDD is associated with an increased risk of falls and fractures after the menopause. VDD also has a negative effect on menopausal symptomatology. VDD, especially its severe form, is associated with an increased risk of CVD risk factors and CVD events. VDD is associated with increased risk and mortality from several cancer types and risk of infections. The evidence from RCTs regarding the effect of vitamin D supplementation on falls, fractures, menopausal symptoms, cardiovascular disease, cancer and infections is not robust. Thus, skeletal health may benefit only when vitamin D is co-administered with calcium, especially in those ≥70 years old and with severe VDD. There is no evidence of a favorable effect on menopausal symptoms or risk of CVD or cancer, except for a modest reduction in cancer-related mortality. Inconsistency still exists regarding its effect on infection risk, disease severity and mortality due to COVID-19.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 564 29 Thesssaloniki, Greece
- Correspondence: ; Tel.: +30-2310-257-150; Fax: +30-2310-281-179
| | | | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 564 29 Thesssaloniki, Greece
| | - Margaret Rees
- Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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13
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Herrmann M. Assessing vitamin D metabolism - four decades of experience. Clin Chem Lab Med 2023; 61:880-894. [PMID: 36639845 DOI: 10.1515/cclm-2022-1267] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
One hundred years ago, the role of vitamin D for bone mineralization and the prevention of rickets was discovered. Vitamin D comprises a group of over 50 metabolites with multiple functions that go far beyond calcium homeostasis and bone mineralization. Approximately 50 years ago, first methods for the measurement of 25-hydroxyvitamin D (25(OH)D) in human blood were developed. Over the years, different analytical principals were employed including competitive protein binding assays, high-performance liquid chromatography, various immunoassay and mass spectrometric formats. Until the recent standardization of serum 25(OH)D measurement, agreement between methods was unsatisfactory. Since then, comparability has improved, but substantial variability between methods remains. With the advent of liquid chromatography tandem mass spectrometry (LC-MS/MS), the accurate determination of 25(OH)D and other metabolites, such as 24,25(OH)2D, becomes increasingly accessible for clinical laboratories. Easy access to 25(OH)D testing has triggered extensive clinical research showing that large parts of the population are vitamin D deficient. The variable response of vitamin D deficient individuals to supplementation indicates that assessing patients' vitamin D stores by measuring 25(OH)D provides limited insight into the metabolic situation. Meanwhile, first evidence has emerged suggesting that the simultaneous measurement of 25(OH)D, 24,25(OH)2D and other metabolites allows a dynamic evaluation of patients' vitamin D status on metabolic principals. This may help to identify patients with functional vitamin D deficiency from those without. It can be expected that research into the assessment vitamin D status will continue for another 50 years and that this will help rationalizing our approach in clinical practice.
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Affiliation(s)
- Markus Herrmann
- Clinical Institute of Medical and Chemical Diagnostics, Medical University of Graz, Graz, Austria
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14
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Zhu X, Chen L, Pan L, Zeng Y, Fu Q, Liu Y, Peng Y, Wang Y, You L. Risk factors of primary and recurrent fractures in postmenopausal osteoporotic Chinese patients: A retrospective analysis study. BMC Womens Health 2022; 22:465. [PMID: 36404305 PMCID: PMC9677643 DOI: 10.1186/s12905-022-02034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As postmenopausal osteoporotic fractures can cause higher rates of disability and mortality in women; it is essential to analyze the factors associated with primary and recurrent fractures in postmenopausal osteoporosis (PMOP) patients. METHODS Retrospective analysis of 2478 PMOP patients aged ≥ 50 years who attended the Shanghai General Hospital from January 2007 to December 2016, including 1239 patients with no fractures and 1239 patients with histories of fractures (1008 in the primary fracture group and 231 in the re-fracture group). All patients' basic clinical data, serum biochemical and bone metabolic markers, bone mineral density (BMD), and other indicators were recorded uniformly. Comparing the differences between the clinical characteristics of patients with primary and recurrent fractures, as well as the differences in the clinical characteristics of patients with primary and recurrent fractures in combination with different diseases, further analyses the risk factors for primary and recurrent fractures in PMOP patients. SPSS.26 was used for statistical analysis. RESULTS Compared to the unfractured group, the fractured group was older and had lower height and bone mineral density (all P < 0.01), with the re-fractured group having lower BMD at each key site than the primary fracture group (all P < 0.01). Analysis of the combined disease subgroups showed that serum BGP levels were lower in the primary and re-fracture patients with diabetes than in the non-diabetic subgroup (P < 0.05), and serum CTX levels were lower in the re-fracture group with diabetes than in the primary fracture group with diabetes (P < 0.05). Patients with recurrent fractures with cardio-vascular diseases had lower BMD than the subgroup without cardio-vascular diseases (P < 0.05) and also had lower BMD than the group with primary fractures with cardio-vascular diseases (P < 0.05). Multiple logistic regression analysis showed that advanced age, overweight, low lumbar spine and total hip BMD were risk factors for primary and recurrent fractures; and comorbid chronic liver and kidney diseases were risk factors for primary fractures. CONCLUSION PMOP patients with advanced age, overweight, low bone mineral density, and comorbid chronic liver and kidney diseases are at greater risk of fractures and require early intervention to reduce fractures occurrence. Moreover, those who are elderly, overweight, and have low bone density should also be aware of the risk of re-fractures.
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Affiliation(s)
- Xiaonan Zhu
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Lin Chen
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Ling Pan
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Yuexi Zeng
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Qiang Fu
- grid.412478.c0000 0004 1760 4628Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Yanbin Liu
- grid.412478.c0000 0004 1760 4628Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Yongde Peng
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Yufan Wang
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
| | - Li You
- grid.412478.c0000 0004 1760 4628Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080 China
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15
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Fisher A, Srikusalanukul W, Fisher L, Smith PN. Comparison of Prognostic Value of 10 Biochemical Indices at Admission for Prediction Postoperative Myocardial Injury and Hospital Mortality in Patients with Osteoporotic Hip Fracture. J Clin Med 2022; 11:jcm11226784. [PMID: 36431261 PMCID: PMC9696473 DOI: 10.3390/jcm11226784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Aim: To evaluate the prognostic impact at admission of 10 biochemical indices for prediction postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In 1273 consecutive patients with HF (mean age 82.9 ± 8.7 years, 73.5% women), clinical and laboratory parameters were collected prospectively, and outcomes were recorded. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were preformed, the number needed to predict (NNP) outcome was calculated. Results: Age ≥ 80 years and IHD were the most prominent clinical factors associated with both PMI (with cardiac troponin I rise) and in-hospital death. PMI occurred in 555 (43.6%) patients and contributed to 80.3% (49/61) of all deaths (mortality rate 8.8% vs. 1.9% in non-PMI patients). The most accurate biochemical predictive markers were parathyroid hormone > 6.8 pmol/L, urea > 7.5 mmol/L, 25(OH)vitamin D < 25 nmol/L, albumin < 33 g/L, and ratios gamma-glutamyl transferase (GGT) to alanine aminotransferase > 2.5, urea/albumin ≥ 2.0 and GGT/albumin ≥ 7.0; the AUC for developing PMI ranged between 0.782 and 0.742 (NNP: 1.84−2.13), the AUC for fatal outcome ranged from 0.803 to 0.722, (NNP: 3.77−9.52). Conclusions: In HF patients, easily accessible biochemical indices at admission substantially improve prediction of hospital outcomes, especially in the aged >80 years with IHD.
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Affiliation(s)
- Alexander Fisher
- Departments of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Departments of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Medical School, Australian National University, Canberra 2605, Australia
- Correspondence:
| | - Wichat Srikusalanukul
- Departments of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
| | - Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Paul N. Smith
- Departments of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Medical School, Australian National University, Canberra 2605, Australia
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16
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Definition, Assessment, and Management of Vitamin D Inadequacy: Suggestions, Recommendations, and Warnings from the Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS). Nutrients 2022; 14:nu14194148. [PMID: 36235800 PMCID: PMC9573415 DOI: 10.3390/nu14194148] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
In the recent years, both the prescriptions of serum 25(OH)D levels assay, and vitamin D supplementation are constantly increasing, as well as the costs to be incurred relating to these specific aspects. As in many other countries, the risk of vitamin D deficiency is particularly high in Italy, as recently confirmed by cohort studies in the general population as well as in patients with metabolic bone disorder. Results confirmed the North-South gradient of vitamin D levels described among European countries, despite the wide use of supplements. Although vitamin D supplementation is also recommended by the Italian Medicine Agency for patients at risk for fragility fracture or for initiating osteoporotic medication, the therapeutic gap for osteoporosis in Italy is very high. There is a consistent proportion of osteoporotic patients not receiving specific therapy for osteoporosis following a fragility fracture, with a poor adherence to the recommendations provided by national guidelines and position paper documents. The failure or inadequate supplementation with vitamin D in patients on antiresorptive or anabolic treatment for osteoporosis is thought to further amplify the problem and exposes patients to a high risk of re-fracture and mortality. Therefore, it is important that attention to its possible clinical consequences must be given. Thus, in light of new evidence from the literature, the SIOMMMS board felt the need to revise and update, by a GRADE/PICO system approach, its previous original recommendations about the definition, prevention, and treatment of vitamin D deficiency in adults, released in 2011. Several key points have been here addressed, such as the definition of the vitamin D status: normality values and optimal values; who are the subjects considered at risk of hypovitaminosis D; opportunity or not of performing the biochemical assessment of serum 25(OH)D levels in general population and in subjects at risk of hypovitaminosis D; the need or not to evaluate baseline serum 25(OH)D in candidate subjects for pharmacological treatment for osteoporosis; how and whether to supplement vitamin D subjects with hypovitaminosis D or candidates for pharmacological treatment with bone active agents, and the general population; how and whether to supplement vitamin D in chronic kidney disease and/or chronic liver diseases or under treatment with drugs interfering with hepatic metabolism; and finally, if vitamin D may have toxic effects in the subject in need of supplementation.
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17
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Habibi Ghahfarrokhi S, Mohammadian-Hafshejani A, Sherwin CMT, Heidari-Soureshjani S. Relationship between serum vitamin D and hip fracture in the elderly: a systematic review and meta-analysis. J Bone Miner Metab 2022; 40:541-553. [PMID: 35639176 DOI: 10.1007/s00774-022-01333-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study investigated the relationship between serum 25-hydroxyvitamin D (25OHD) levels and the occurrence of hip fractures in the elderly using a systematic review and meta-analysis approach. MATERIALS AND METHODS PubMed, Web of Science, and Scopus were used to identify studies that outlined an association between serum 25OHD and the occurrence of a hip fracture in a geriatric patient. The analysis calculated odds ratios (OR) for a hip fracture using a random-effects model. RESULTS In this study, 28 studies were included, 61,744 elderlies and 9767 cases (15.81%) of hip fractures. In the lowest vs. highest categories of vitamin D in the elderly, pooled OR of hip fractures was 1.80 (95% CI 1.56-2.07, P ≤ 0.001), and modified OR was equal to 1.40 (95% CI 1.20-1.63 P ≤ 0.001). A subgroup analysis showed that the OR of a hip fracture was 2.16 (1.49-3.11, P ≤ 0.001) in case-control studies; 1.52 (1.29-1.79, P = 0.001) in cohort studies; and 1.41 (1.18-1.70, P ≤ 0.001) in case-cohort studies. CONCLUSION Low serum vitamin D levels in the elderly are associated with an increase in the odds of hip fracture.
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Affiliation(s)
- Shahrzad Habibi Ghahfarrokhi
- Department of Social Medicine, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Social Determinants of Health Research Center, Shahrekord, Iran
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Abdollah Mohammadian-Hafshejani
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
- Dayton Children's Hospital, 1 Childrens Plz, Dayton, OH, 45404-1873, USA
| | - Saeid Heidari-Soureshjani
- Deputy of Research and Technology Kashani Boulevard, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- Circuit of Research and Technology, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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18
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Schwingshackl L, Bröckelmann N, Beyerbach J, Werner SS, Zähringer J, Schwarzer G, Meerpohl JJ. An Empirical Evaluation of the Impact Scenario of Pooling Bodies of Evidence from Randomized Controlled Trials and Cohort Studies in Nutrition Research. Adv Nutr 2022; 13:1774-1786. [PMID: 35416239 PMCID: PMC9526829 DOI: 10.1093/advances/nmac042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/16/2021] [Accepted: 04/08/2022] [Indexed: 01/28/2023] Open
Abstract
Only very few Cochrane nutrition reviews include cohort studies (CSs), but most evidence in nutrition research comes from CSs. We aimed to pool bodies of evidence (BoE) from randomized controlled trials (RCTs) derived from Cochrane reviews with matched BoE from CSs. The Cochrane Database of Systematic Reviews and MEDLINE were searched for systematic reviews (SRs) of RCTs and SRs of CSs. BoE from RCTs were pooled together with BoE from CSs using random-effects and common-effect models. Heterogeneity, 95% prediction intervals, contributed weight of BoE from RCTs to the pooled estimate, and whether integration of BoE from CSs modified the conclusion from BoE of RCTs were evaluated. Overall, 80 diet-disease outcome pairs based on 773 RCTs and 720 CSs were pooled. By pooling BoE from RCTs and CSs with a random-effects model, for 45 (56%) out of 80 diet-disease associations the 95% CI excluded no effect and showed mainly a reduced risk/inverse association. By pooling BoE from RCTs and CSs, median I2 = 46% and the median contributed weight of RCTs to the pooled estimates was 34%. The direction of effect between BoE from RCTs and pooled effect estimates was rarely opposite (n = 17; 21%). The integration of BoE from CSs modified the result (by examining the 95% CI) from BoE of RCTs in 35 (44%) of the 80 diet-disease associations. Our pooling scenario showed that the integration of BoE from CSs modified the conclusion from BoE of RCTs in nearly 50% of the associations, although the direction of effect was mainly concordant between BoE of RCTs and pooled estimates. Our findings provide insights for the potential impact of pooling both BoE in Cochrane nutrition reviews. CSs should be considered for inclusion in future Cochrane nutrition reviews, and we recommend analyzing RCTs and CSs in separate meta-analyses, or, if combined together, with a subgroup analysis.
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Affiliation(s)
| | - Nils Bröckelmann
- Institute for Evidence in Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah S Werner
- Institute for Evidence in Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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19
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Faraj M, Napoli N. The Impact of Diet on Bone and Fracture Risk in Diabetes. Curr Osteoporos Rep 2022; 20:26-42. [PMID: 35201556 DOI: 10.1007/s11914-022-00725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recently published scientific evidence on the effects of diet on diabetes and skeletal health. RECENT FINDINGS The impact of diet on overall health has been a growing topic of interest among researchers. An inappropriate eating habit is a relatively modified risk factor for diabetes in adults. Parallel with the significant increase in the incidence of diabetes mellitus worldwide, many studies have shown the benefits of lifestyle modifications, including diet and exercise for people with, or at risk of developing, diabetes. In the last years, accumulating evidence suggests that diabetes is a risk factor for bone fragility. As lifestyle intervention represents an effective option for diabetes management and treatment, there is potential for an effect on bone health. Healthy lifestyle is critical to prevent bone fragility. However, more studies are needed to fully understand the impact of diet and weight loss on fracture risk in diabetics.
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Affiliation(s)
- M Faraj
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy.
- Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA.
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20
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Hospitalisations for falls and hip fractures attributable to vitamin D deficiency in older Australians. Br J Nutr 2021; 126:1682-1686. [PMID: 33509323 DOI: 10.1017/s0007114521000416] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) <50 nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches.
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21
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Liu D, Meng X, Tian Q, Cao W, Fan X, Wu L, Song M, Meng Q, Wang W, Wang Y. Vitamin D and Multiple Health Outcomes: An Umbrella Review of Observational Studies, Randomized Controlled Trials, and Mendelian Randomization Studies. Adv Nutr 2021; 13:1044-1062. [PMID: 34999745 PMCID: PMC9340982 DOI: 10.1093/advances/nmab142] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/29/2020] [Accepted: 11/19/2021] [Indexed: 12/18/2022] Open
Abstract
Observational studies, randomized controlled trials (RCTs), and Mendelian randomization (MR) studies have yielded inconsistent results on the associations of vitamin D concentrations with multiple health outcomes. In the present umbrella review we aimed to evaluate the effects of low vitamin D concentrations and vitamin D supplementation on multiple health outcomes. We summarized current evidence obtained from meta-analyses of observational studies that examined associations between vitamin D concentrations and multiple health outcomes, meta-analyses of RCTs that investigated the effect of vitamin D supplementation on multiple health outcomes, and MR studies that explored the causal associations of vitamin D concentrations with various diseases (international prospective register of systematic reviews PROSPERO registration number CRD42018091434). A total of 296 meta-analyses of observational studies comprising 111 unique outcomes, 139 meta-analyses of RCTs comprising 46 unique outcomes, and 73 MR studies comprising 43 unique outcomes were included in the present umbrella review. Twenty-eight disease outcomes were identified by both meta-analyses of observational studies and MR studies. Seventeen of these reported disease outcomes had consistent results, demonstrating that lower concentrations of vitamin D were associated with a higher risk for all-cause mortality, Alzheimer's disease, hypertension, schizophrenia, and type 2 diabetes. The combinations of consistent evidence obtained by meta-analyses of observational studies and MR studies together with meta-analyses of RCTs showed that vitamin D supplementation was associated with a decreased risk for all-cause mortality but not associated with the risk for Alzheimer's disease, hypertension, schizophrenia, or type 2 diabetes. The results indicated that vitamin D supplementation is a promising strategy with long-term preventive effects on multiple chronic diseases and thus has the potential to decrease all-cause mortality. However, the current vitamin D supplementation strategy might not be an efficient intervention approach for these diseases, suggesting that new strategies are highly needed to improve the intervention outcomes.
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Affiliation(s)
- Di Liu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Xiaoni Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Weijie Cao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xin Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Lijuan Wu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Manshu Song
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Qun Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, Shandong, China
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22
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Schwingshackl L, Balduzzi S, Beyerbach J, Bröckelmann N, Werner SS, Zähringer J, Nagavci B, Meerpohl JJ. Evaluating agreement between bodies of evidence from randomised controlled trials and cohort studies in nutrition research: meta-epidemiological study. BMJ 2021; 374:n1864. [PMID: 34526355 PMCID: PMC8441535 DOI: 10.1136/bmj.n1864] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the agreement between diet-disease effect estimates of bodies of evidence from randomised controlled trials and those from cohort studies in nutrition research, and to investigate potential factors for disagreement. DESIGN Meta-epidemiological study. DATA SOURCES Cochrane Database of Systematic Reviews, and Medline. REVIEW METHODS Population, intervention or exposure, comparator, outcome (PI/ECO) elements from a body of evidence from cohort studies (BoE(CS)) were matched with corresponding elements of a body of evidence from randomised controlled trials (BoE(RCT)). Pooled ratio of risk ratios or difference of mean differences across all diet-disease outcome pairs were calculated. Subgroup analyses were conducted to explore factors for disagreement. Heterogeneity was assessed through I2 and τ2. Prediction intervals were calculated to assess the range of possible values for the difference in the results between evidence from randomised controlled trials and evidence from cohort studies in future comparisons. RESULTS 97 diet-disease outcome pairs (that is, matched BoE(RCT) and BoE(CS)) were identified overall. For binary outcomes, the pooled ratio of risk ratios comparing estimates from BoE(RCT) with BoE(CS) was 1.09 (95% confidence interval 1.04 to 1.14; I2=68%; τ2=0.021; 95% prediction interval 0.81 to 1.46). The prediction interval indicated that the difference could be much more substantial, in either direction. We further explored heterogeneity and found that PI/ECO dissimilarities, especially for the comparisons of dietary supplements in randomised controlled trials and nutrient status in cohort studies, explained most of the differences. When the type of intake or exposure between both types of evidence was identical, the estimates were similar. For continuous outcomes, small differences were observed between randomised controlled trials and cohort studies. CONCLUSION On average, the difference in pooled results between estimates from BoE(RCT) and BoE(CS) was small. But wide prediction intervals and some substantial statistical heterogeneity in cohort studies indicate that important differences or potential bias in individual comparisons or studies cannot be excluded. Observed differences were mainly driven by dissimilarities in population, intervention or exposure, comparator, and outcome. These findings could help researchers further understand the integration of such evidence into prospective nutrition evidence syntheses and improve evidence based dietary guidelines.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sara Balduzzi
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Bröckelmann
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah S Werner
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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23
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Wilson LF, Xu Z, Mishra GD, Dobson AJ, Doust J. Did changes to recommended testing criteria affect the rate of vitamin D testing among Australian women. Arch Osteoporos 2020; 15:162. [PMID: 33067691 DOI: 10.1007/s11657-020-00840-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing. PURPOSE Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria. METHODS We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62). CONCLUSION The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.
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Affiliation(s)
- Louise Forsyth Wilson
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | - Zhiwei Xu
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Gita Devi Mishra
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Annette Jane Dobson
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Jenny Doust
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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24
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Wang N, Ji J, Yu S, Chang J, Chen Y, Yu B. In reply to the letter to the editor regarding "The Relationship Between Serum Vitamin D and Fracture Risk in the Elderly: A Meta-Analysis". J Orthop Surg Res 2020; 15:324. [PMID: 32795312 PMCID: PMC7427934 DOI: 10.1186/s13018-020-01820-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ning Wang
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Jindou Ji
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Shengwen Yu
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Jinlei Chang
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Yungang Chen
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Bo Yu
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China.
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Vitiello R, Perisano C, Covino M, Perna A, Bianchi A, Oliva MS, Greco T, Sirgiovanni M, Maccauro G. Euthyroid sick syndrome in hip fractures: Valuation of vitamin D and parathyroid hormone axis. Injury 2020; 51 Suppl 3:S13-S16. [PMID: 31983423 DOI: 10.1016/j.injury.2020.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/25/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femur fracture is an acute event with a high incidence and mortality worldwide. Euthyroid sick syndrome (ESS) is a disease characterized by an alteration of fT3 in the absence of a primary thyroid pathology. The aim of the study is evaluating the association between femur fracture and ESS and post-operative fluctuations of the parathyroid hormone (PTH) and vitamin D and their physio-pathological implications. MATERIALS AND METHODS All patients older than 65 years, admitted in our emergency care unit with a diagnosis of proximal femur fracture were recruited. Exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, any thyroid or endocrine pathology and use of drugs with thyroidal interactions. All patients underwent surgery within 48 h from the injury. The outcome of the study is the presence of ESS, moreover, post-operative fluctuations of the PTH and vitamin D are also evaluated. RESULT 45 patients (13 men and 32 females) were enrolled. 20 patients had a normal thyroidal function, while 23 had a diagnosis of ESS. Mean age was 81.9. BMI was lower in the ESS group than the controls (25,3 vs 22,7; p < 0.02). In the ESS group a significantly higher decrease in Vitamin D levels was observed, compared to controls (3.96 ng/ml, p<0.001). Values of PTH were significantly different between the two groups, with a level 44.29 pg/ml lower among the ESS group compared to controls (p = 0.002). In the ESS group a significant decrease of serum calcium on the first post-surgery day was observed, compared to controls (8,7 vs 8,3; p < 0,01). There were no differences in the CCI, serum electrolytes and other variables collected between the two groups. CONCLUSION Part of the geriatric population suffering from fractures of the proximal femur are affected by ESS. This population displays anomalies of the Vitamin d-PTH axis and a lower BMI.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Carlo Perisano
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Marcello Covino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Antonio Bianchi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Maria Serena Oliva
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Tommaso Greco
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia.
| | | | - Giulio Maccauro
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
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26
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Cher EWL, Allen JC, Moo IH, Lo EC, Peh B, Howe TS, Koh JSB. Sub-optimal serum 25-hydroxyvitamin D level affects 2-year survival after hip fracture surgery. J Bone Miner Metab 2020; 38:555-562. [PMID: 31974676 DOI: 10.1007/s00774-019-01082-0] [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: 10/22/2019] [Accepted: 12/26/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Hypovitaminosis D is a common condition seen in patients with acute hip fracture. We hypothesize that in addition to the other prognosticating factors, hypovitaminosis D may affect survival in patients treated for hip fractures. The objective of this study is to evaluate the impact of serum level of 25-hydroxyvitamin D (25(OH)D) on the survivability after surgical fixation of hip fractures. MATERIALS AND METHODS We retrospectively studied data collected from January 2013 through December 2015 at a large tertiary hospital in Singapore. Patient's age, gender, Charlson Comorbidity Index (CCI), delay of surgery, fracture patterns, ASA score, as well as their pre-operative serum levels of 25(OH)D, albumin and calcium were examined. Univariate and multivariate logistic regression were used to analyse post-operative outcomes including short (inpatient, 30 and 90 days) and long-term mortality (2 years). RESULTS Data from 1004 patients were used. Information on the serum level of 25(OH)D was available in 80% of them (n = 801) and more than 90% (n = 735) of the patients had a baseline serum level of less than 30 ng/ml. Mortality rate within this group were 1.1% (n = 9) at 30 days, 1.9% (n = 15) at 90 days and 11.0% (n = 88) at 2 years follow up. Hypovitaminosis D was not a significant risk predictor for short-term mortality, but found to be a significant predictor at 2 years. CONCLUSIONS In this study, we showed a high prevalence of hypovitaminosis D among the osteoporotic hip fracture population and its impact on 2-year survivorship after hip fracture surgery.
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Affiliation(s)
- Eric Wei Liang Cher
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - John Carson Allen
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Ing How Moo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ean Chung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Bryan Peh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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27
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Segheto KJ, Pereira M, Silva DCGD, Carvalho CJD, Massardi FR, Kakehasi AM, Juvanhol LL, Longo GZ. Vitamin D and bone health in adults: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2020; 26:3221-3244. [PMID: 34378711 DOI: 10.1590/1413-81232021268.15012020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Low bone health is associated with vitamin D deficiency in older individuals; however, this association is not well established in adults. The aim of the study was to analyze the association between serum concentrations of 25-hydroxyvitamin D and bone health in adults by systematic review and meta-analysis. The search was carried out in the LILACS, PubMed, Scopus, Web of Science, ScienceDirect databases from March 2017 to October 2018 with adult individuals (20-59 years). Bone health was evaluation performed through dual X-ray absorptiometry and serum concentrations of 25(OH)D. The random effect model was used to analyze data from bone mineral content and bone mineral. Random effects models were used and the sources of heterogeneity were explored by means of meta-regression. Thirty-five articles were selected. There was positive correlation between vitamin D and bone health in most of the evaluated sites. Correlation was observed in the analysis of subgroups for lumbar spine among men. When stratified, the studies presented high heterogeneity, which was explained by the sample size, mean serum vitamin D levels and risk of bias. Vitamin D is positively correlated to bone health in adult individuals.
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Affiliation(s)
- Kátia Josiany Segheto
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | | | | | | | | | - Leidjaira Lopes Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Giana Zarbato Longo
- Departamento de Nutrição, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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28
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Çolak Y, Afzal S, Nordestgaard BG. 25-Hydroxyvitamin D and Risk of Osteoporotic Fractures: Mendelian Randomization Analysis in 2 Large Population-Based Cohorts. Clin Chem 2020; 66:676-685. [DOI: 10.1093/clinchem/hvaa049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/24/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Whether low plasma 25-hydroxyvitamin D concentrations cause osteoporotic fractures is unclear. We tested the hypothesis that low plasma 25-hydroxyvitamin D concentrations are associated with increased risk of osteoporotic fractures using a Mendelian randomization analysis.
Methods
We genotyped 116 335 randomly chosen white Danish persons aged 20–100 years in 2 population-based cohort studies for plasma 25-hydroxyvitamin D decreasing genotypes in CYP2R1 (rs117913124 and rs12794714), DHCR7 (rs7944926 and rs11234027), GEMIN2 (rs2277458), and HAL (rs3819817); 35 833 had information on plasma 25-hydroxyvitamin D. We assessed risk of total, osteoporotic, and anatomically localized fractures from 1981 through 2017. Information on fractures and vital status was obtained from nationwide registries.
Results
During up to 36 years of follow-up, we observed 17 820 total fractures, 10 861 osteoporotic fractures, and 3472 fractures of hip or femur. Compared with individuals with 25-hydroxyvitamin D ≥ 50nmol/L, multivariable adjusted hazard ratios (95% CIs) for total fractures were 1.03 (0.97–1.09) for individuals with 25–49.9 nmol/L, 1.19 (1.10–1.28) for individuals with 12.5–24.9 nmol/L, and 1.39 (1.21–1.60) for individuals with 25-hydroxyvitamin D < 12.5 nmol/L. Corresponding hazard ratios were 1.07 (1.00–1.15), 1.25 (1.13–1.37), and 1.49 (1.25–1.77) for osteoporotic fractures and 1.09 (0.98–1.22), 1.37 (1.18–1.57), and 1.41 (1.09–1.81) for fractures of hip or femur, respectively. Hazard ratios per 1 increase in vitamin D allele score, corresponding to 3.0% (approximately 1.6 nmol/L) lower 25-hydroxyvitamin D concentrations, were 0.99 (0.98–1.00) for total fractures, 0.99 (0.97–1.00) for osteoporotic fractures, and 0.98 (0.95–1.00) for fractures of hip or femur.
Conclusions
Low plasma 25-hydroxyvitamin D concentrations were associated with osteoporotic fractures; however, Mendelian randomization analysis provided no evidence supporting a causal role for vitamin D in the risk for osteoporotic fractures.
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Affiliation(s)
- Yunus Çolak
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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29
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Wang N, Chen Y, Ji J, Chang J, Yu S, Yu B. The relationship between serum vitamin D and fracture risk in the elderly: a meta-analysis. J Orthop Surg Res 2020; 15:81. [PMID: 32103764 PMCID: PMC7045381 DOI: 10.1186/s13018-020-01603-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of osteoporotic fractures has increased rapidly, and because of the poor prognosis and high mortality associated with osteoporotic fractures, they remain a prospective research area globally. One way to reduce their incidence is to investigate their intervention risk factors in the elderly. Hence, this study explores the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and osteoporotic fractures in elderly patients through a meta-analysis. METHODS We conducted our literature search mainly in PubMed and Embase for identifying studies that investigated the relationship between serum 25(OH)D levels and the risk for osteoporotic fractures. We performed categorical analysis, heterogeneity checks, publication bias analysis, and subgroup analyses. RESULTS In total, 20 studies were included, of which 4 were case-cohort studies and 16 were cohort studies. A total of 41,738 patients from 20 studies were included in the meta-analysis, of which 5916 had fractures, including 3237 hip fractures. By combining the lowest and highest categories of relative risks (RRs) and 95% confidence intervals (CIs), it was suggested that lower serum 25-hydroxyvitamin D levels may be a risk factor for fractures. RR (95% CI) for total and hip fractures were 1.11 (0.99, 1.24) and 0.89 (0.80, 0.98) after adjustments. CONCLUSIONS Our study showed that compared to low serum 25(OH)D levels, high serum 25(OH)D levels reduce the risk of hip fractures in the patients aged 60 years or older. In contrast, serum 25(OH)D has no significant relationship with total fracture risk.
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Affiliation(s)
- Ning Wang
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Yungang Chen
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Jindou Ji
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Jinlei Chang
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Shengwen Yu
- Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
| | - Bo Yu
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingshi Road16369, Jinan, 250014 China
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30
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Zhuang H, Wang P, Li Y, Lin J, Yao X, Xu H. Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis. Orthop Surg 2020; 12:194-198. [PMID: 31943831 PMCID: PMC7031597 DOI: 10.1111/os.12605] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.
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Affiliation(s)
- Hua‐feng Zhuang
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Pei‐wen Wang
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Yi‐zhong Li
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Jin‐kuang Lin
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Xue‐dong Yao
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Hao Xu
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
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Yao P, Bennett D, Mafham M, Lin X, Chen Z, Armitage J, Clarke R. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1917789. [PMID: 31860103 PMCID: PMC6991219 DOI: 10.1001/jamanetworkopen.2019.17789] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022] Open
Abstract
Importance Vitamin D and calcium supplements are recommended for the prevention of fracture, but previous randomized clinical trials (RCTs) have reported conflicting results, with uncertainty about optimal doses and regimens for supplementation and their overall effectiveness. Objective To assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D (25[OH]D) in observational studies and the risks of fracture associated with supplementation with vitamin D alone or in combination with calcium in RCTs. Data Sources PubMed, EMBASE, Cochrane Library, and other RCT databases were searched from database inception until December 31, 2018. Searches were performed between July 2018 and December 2018. Study Selection Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included. Randomized clinical trials compared vitamin D or vitamin D and calcium with control. Data Extraction and Synthesis Two researchers independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and assessed possible bias. Rate ratios (RRs) were estimated using fixed-effects meta-analysis. Data extraction and synthesis took place between July 2018 and June 2019. Main Outcomes and Measures Any fracture and hip fracture. Results In a meta-analysis of 11 observational studies (39 141 participants, 6278 fractures, 2367 hip fractures), each increase of 10.0 ng/mL (ie, 25 nmol/L) in 25 (OH)D concentration was associated with an adjusted RR for any fracture of 0.93 (95% CI, 0.89-0.96) and an adjusted RR for hip fracture of 0.80 (95% CI, 0.75-0.86). A meta-analysis of 11 RCTs (34 243 participants, 2843 fractures, 740 hip fractures) of vitamin D supplementation alone (daily or intermittent dose of 400-30 000 IU, yielding a median difference in 25[OH]D concentration of 8.4 ng/mL) did not find a reduced risk of any fracture (RR, 1.06; 95% CI, 0.98-1.14) or hip fracture (RR, 1.14; 95% CI, 0.98-1.32), but these trials were constrained by infrequent intermittent dosing, low daily doses of vitamin D, or an inadequate number of participants. In contrast, a meta-analysis of 6 RCTs (49 282 participants, 5449 fractures, 730 hip fractures) of combined supplementation with vitamin D (daily doses of 400-800 IU, yielding a median difference in 25[OH]D concentration of 9.2 ng/mL) and calcium (daily doses of 1000-1200 mg) found a 6% reduced risk of any fracture (RR, 0.94; 95% CI, 0.89-0.99) and a 16% reduced risk of hip fracture (RR, 0.84; 95% CI, 0.72-0.97). Conclusions and Relevance In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D alone was associated with reduced risk of fracture, but daily supplementation with both vitamin D and calcium was a more promising strategy.
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Affiliation(s)
- Pang Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Xu Lin
- Chinese Academy of Sciences Key Laboratory of Nutrition, Metabolism, and Food Safety, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences and University of the Chinese Academy of Sciences, Shanghai, China
- Shanghai Institute for Biological Sciences, Chinese Academy of Sciences and University of the Chinese Academy of Sciences, Shanghai, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Armitage
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Dretakis K, Igoumenou VG. The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type. Aging Clin Exp Res 2019; 31:1501-1507. [PMID: 30701437 DOI: 10.1007/s40520-019-01132-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fragility fractures of the hip are associated with high morbidity and mortality, and represent a rather devastating consequence of osteoporosis. Hip fractures are traditionally investigated as a whole, although it has been recently implied that distinct pathogenic mechanisms may lead either to trochanteric or subcapital fractures. AIMS To investigate whether differences exist by hip fracture type with respect to serum 25(OH)D (vitamin D) and parathyroid hormone (PTH) levels, in addition to epidemiological and demographic data, including history of falls. METHODS The inclusion criteria were met by 116 patients [48 men and 68 women; mean age 80.8 ± 8.5 (range 62-94) years]. Patients were analyzed according to hip fracture type, history of falls, and vitamin D and PTH status. RESULTS Older age, recurrent falls, serum levels of PTH > 65 pg/ml, and severe vitamin D deficiency were found to be associated with trochanteric fractures. Additionally, older age, female gender, PTH > 65 pg/ml, and severe vitamin D deficiency were related to recurrent falls. Meanwhile, patients with absence of PTH response to low vitamin D levels, were not repeated fallers and suffered mostly from subcapital fractures. DISCUSSION AND CONCLUSION Elevated PTH levels predispose both to falls and trochanteric fractures, while vitamin D-deficient patients with normal PTH levels are mostly related to subcapital fractures. It is thereby indicated that different pathophysiological processes lie behind subcapital and trochanteric fractures. A better understanding of these mechanisms may assist in the development of prevention strategies for individuals recognized at risk for falls and either type of hip fracture.
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Affiliation(s)
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Kuwabara A, Tsugawa N, Mizuno K, Ogasawara H, Watanabe Y, Tanaka K. A simple questionnaire for the prediction of vitamin D deficiency in Japanese adults (Vitaimn D Deficiency questionnaire for Japanese: VDDQ-J). J Bone Miner Metab 2019; 37:854-863. [PMID: 30721357 DOI: 10.1007/s00774-018-0984-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
Vitamin D deficiency (VDD) is associated with an increased risk of various diseases. Serum 25-hydroxyvitamin D [25(OH)D] concentration is the best marker for vitamin D status and its concentration < 20 ng/mL indicates VDD. However, its measurement is not easily applicable for the evaluation of vitamin D status in the general population because of its cost. Therefore, we aimed to develop a simple questionnaire for easily identifying the risk of VDD. From the total sample (649 healthy subjects aged 19-70 years), 434 and 215 subjects were randomly assigned to the derivation and the validation cohort, respectively. Prediction model for VDD was developed by backward logistic regression analysis. The regression β coefficients of the significant predictors were transformed into integral numbers and used for the individual score. These individual scores were summed to calculate the total risk score (VDD questionnaire for Japanese score: VDDQ-J score). VDD was present in 54.1% of the total subjects. The model for the prediction of VDD consisted of 7 predictors. Areas under the curve were 0.78 and 0.75 in the data set of internal validation and of the external validation, respectively. The cutoff value was determined to be 31 points (range 0-54) with the sensitivity/specificity and positive predictive value/negative predictive value of 61%/79%, and 81%/57%, respectively. Our VDDQ-J score is easy to answer by the wide range of subjects, and well predicts VDD. This risk score would be useful to identify subjects at risk for VDD both in clinical and epidemiological settings.
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Affiliation(s)
- Akiko Kuwabara
- Department of Clinical Nutrition, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan.
| | - Naoko Tsugawa
- Department of Health and Nutrition, Osaka Shoin Women's University, 4-2-26 Hishiyanishi, Higashiosaka, Osaka, 577-8550, Japan
| | - Kei Mizuno
- RIKEN Compass to Healthy Life Research Complex Program, 6-7-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Honami Ogasawara
- Department of Health and Nutrition, Osaka Shoin Women's University, 4-2-26 Hishiyanishi, Higashiosaka, Osaka, 577-8550, Japan
| | - Yasuyoshi Watanabe
- RIKEN Compass to Healthy Life Research Complex Program, 6-7-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Kiyoshi Tanaka
- Department of Faculty of Nutrition, Kobe Gakuin University, 518, Ikawadanicho-Arise, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
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Abstract
Vitamin D deficiency affects nearly one-sixth of the world's population and is common in patients undergoing foot and ankle surgery. Vitamin D is critical for calcium homeostasis and plays an important role in the maintenance of bone health. Patients undergoing foot and ankle procedures can be evaluated preoperatively with vitamin D level testing, and deficiencies can be addressed with either preoperative or postoperative supplementation. Current data suggest that patients with adequate vitamin D levels may have better outcomes, but the details are not yet clear. Vitamin D supplementation is well tolerated with rare side effects.
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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Liang J, Meng WD, Yang JM, Li SL, Zhong MN, Hou XX, Wang R, Long YY, Bao LX, Bao M. The association between liver cirrhosis and fracture risk: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 89:408-413. [PMID: 29885255 DOI: 10.1111/cen.13762] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/14/2018] [Accepted: 06/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Liver cirrhosis (LC) was associated with an increased risk of osteoporosis; however, the association between LC and fracture risk was inconclusive. Therefore, this systematic review and meta-analysis aims to explore the association between LC and fracture risk. DESIGN To identify related literature, a systematic search of PubMed, EMBASE, Web of science and the Cochrane Library from 1965 to July 2017 without language limitation was performed. The random-effects model described by DerSimonian and Laird was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Eventually, 5 cohort and 3 case-control studies were identified, which included 321 035 subjects and 31 272 fracture cases. The pooled OR of the association between LC and any fracture risk, hip fracture, spine/trunk fracture and limb fracture was 1.94 (95% CI, 1.59-2.37), 2.11 (95% CI, 1.34-3.32), 2.00 (95% CI, 1.50-2.67) and 1.82 (95% CI, 1.65-2.01), respectively. CONCLUSION In conclusion, this study indicates that cirrhotic patients have an increased risk of fracture. Preventive measures should be instituted as early as possible.
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Affiliation(s)
- Jie Liang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-Dong Meng
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun-Ming Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng-Long Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mi-Na Zhong
- Changde Third People's Hospital of Hunan, Changde, China
| | - Xuan-Xuan Hou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ran Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Ying Long
- Shaoyang Maternal and Child Health Care Hospital of Hunan, Shaoyang, China
| | - Liang-Xiao Bao
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ming Bao
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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Kühn J, Trotz P, Stangl GI. Prevalence of vitamin D insufficiency and evidence for disease prevention in the older population. Z Gerontol Geriatr 2018; 51:567-572. [PMID: 29666919 DOI: 10.1007/s00391-018-1390-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/05/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022]
Abstract
The prevalence of vitamin D insufficiency, usually assessed by the analysis of circulating 25-hydroxyvitamin D (25[OH])D), is very high in the aging German population. An important factor that reduces endogenous vitamin D synthesis in older persons is physical inactivity or care-dependency that limits the time spent outside. Additionally, it has been suggested that the age-dependent decline in the glomerular filtration rate is associated with a reduced production of bioactive calcitriol. As this phenomenon is not detectable by the assessment of 25(OH)D, it is necessary to analyze the level of parathyroid hormone as a marker of calcitriol function. Because 25(OH)D levels are highly correlated with an active and healthy life style, data from epidemiological studies are not necessarily suitable to elucidate the role of vitamin D in disease prevention. Recently published meta-analyses of randomized controlled trials (RCTs) showed moderate effects of vitamin D supplementation on fracture risk and found that vitamin D was more effective when administered in combination with calcium. The role of vitamin D in the prevention of falls and frailty remains unclear. Much evidence has demonstrated the beneficial effects of vitamin D on respiratory tract infections and asthma, which are very relevant health issues in the older population. To conclude, vitamin D, particularly combined with calcium, has moderately beneficial effects on the skeletal system and is useful for the prevention of respiratory tract infections.
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Affiliation(s)
- Julia Kühn
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120, Halle (Saale), Germany.,Competence Cluster of Cardiovascular Health and Nutrition (nutriCARD), Halle-Jena-Leipzig, Germany
| | - Paula Trotz
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120, Halle (Saale), Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120, Halle (Saale), Germany. .,Competence Cluster of Cardiovascular Health and Nutrition (nutriCARD), Halle-Jena-Leipzig, Germany.
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Nurmi-Lüthje I, Tiihonen R, Paattiniemi EL, Naboulsi H, Pigg S, Sarkkinen H, Kaukonen JP, Toivanen A, Salmio K, Kataja M, Lüthje P. Remarkable improvement in serum 25-hydroxyvitamin levels among hip fracture patients over a 12-year period: a prospective study in South-eastern Finland. Osteoporos Int 2018; 29:837-845. [PMID: 29260288 PMCID: PMC5854727 DOI: 10.1007/s00198-017-4344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
Hypovitaminosis D is a problem among hip fracture patients. In a 1-year cohort study comprising 245 hip fracture patients (mean age of females 81 years and males 78 years) from south-eastern Finland, the mean 25-hydroxyvitamin D [S-25(OH)D] concentration was 73(SD 31) nmol/L. Vitamin D supplementation has been integrated into our current practice. INTRODUCTION The objectives of this study are to verify vitamin D levels among hip fracture patients and to compare the results with a similar study conducted in the same two hospitals covering the same geographic area 12 years ago. METHODS A prospective cohort comprising 245 Caucasian hip fracture patients was enrolled in the study in two acute hospitals in south-eastern Finland (61° N) over a 12-month period in 2015-2016. The S-25(OH)D was measured using 25-hydroxyvitamin D electrochemiluminescence binding assay. The S-25(OH)D concentrations were compared with the corresponding concentrations of a similar cohort analyzed in the same two hospitals 12 years ago. RESULTS Of the 245 patients, 70% were women with a mean age of 81 (SD 10) years, while the men had a mean age of 78 (SD 12) years (p < 0.01). The total mean S-25(OH)D concentration was 73 (SD 31.3) nmol/L. Regional differences were found: 15% in hospital A and 36% in hospital B had a S-25(OH(D level < 50 nmol/L, and the mean S-25(OH)D level was 79.2 (SD 31.7) nmol/L in hospital A and 62.4 (SD 27.5) nmol/L in hospital B (p < 0.001). No differences were found in S-25(OH)D concentrations by either the place of residence or the time of year. Overall, the percentage of patients with a sufficient vitamin D level (> 50 nmol/L) was remarkably higher in 2015-2016 (77%) than in 2003-2004 (22%). CONCLUSION Our results indicate that vitamin D supplementation has been widely integrated into our current practice. However, regional differences were found in the S-25(OH)D concentrations for which the reasons are unknown.
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Affiliation(s)
- I Nurmi-Lüthje
- Department of Public Health, Helsinki University, Mannerheimintie 172, FI-00300, Helsinki, Finland.
- , Helsinki, Finland.
| | - R Tiihonen
- Department of Orthopedics and Traumatology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI-15850, Lahti, Finland
| | - E-L Paattiniemi
- Centre for Laboratory Services, Päijät-Häme Social and Health Care Group, Keskussairaalankatu 7, FI-15850, Lahti, Finland
| | - H Naboulsi
- Department of Information management, Päijät-Häme Social and Health Care Group, Keskussairaalankatu 7, FI-15850, Lahti, Finland
| | - S Pigg
- Department of Surgery, North Kymi Hospital, FI-45750, Kuusankoski, Finland
| | - H Sarkkinen
- Centre for Laboratory Services, Päijät-Häme Social and Health Care Group, Keskussairaalankatu 7, FI-15850, Lahti, Finland
| | - J-P Kaukonen
- Terveystalo, Aleksanterinkatu 11-13, FI-15110, Lahti, Finland
| | - A Toivanen
- Department of Surgery, Kymenlaakso Central Hospital, Kotkantie 41, FI-48210, Kotka, Finland
| | - K Salmio
- Department of Surgery, North Kymi Hospital, FI-45750, Kuusankoski, Finland
| | - M Kataja
- National Institute for Health and Welfare, Mannerheimintie 166, FI-0027, Helsinki, Finland
| | - P Lüthje
- Department of Surgery, North Kymi Hospital, FI-45750, Kuusankoski, Finland
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Wang Y, Dai J, Zhong W, Hu C, Lu S, Chai Y. Association between Serum Cholesterol Level and Osteoporotic Fractures. Front Endocrinol (Lausanne) 2018; 9:30. [PMID: 29483896 PMCID: PMC5816040 DOI: 10.3389/fendo.2018.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/23/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Previous epidemiological studies have found an association between serum cholesterol level and bone mineral density. However, epidemiological studies evaluating the association between serum cholesterol level and the incidence of osteoporotic fracture are scant. Therefore, the objective of this study was to investigate whether serum cholesterol levels in Chinese participants aged 55 years or older was associated with an increased risk of osteoporotic fracture. MATERIALS AND METHODS We performed a cross-sectional study, including 1,791 participants (62.1% postmenopausal women and 213 fractures). Standardized self-administered questionnaires, physical examination, laboratory tests, and dual-energy X-ray absorptiometry examination were performed. Multivariate-adjusted logistic regression models were used to evaluate associations between serum cholesterol [total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C)] levels and the osteoporotic fracture risk. RESULTS After adjusting for potential confounding factors, there were no associations between per SD increase in TC and LDL level and an increased risk of osteoporotic fracture in total participants, and in men and women as individual groups. There was a significant association between per SD increase in HDL-C level and an increased risk of osteoporotic fracture in total participants [odds ratios (OR) 1.20, 95% confidence interval (CI) 1.03, 1.40, P = 0.023] and in women (OR 1.37, 95% CI 1.12, 1.68, P = 0.003), whereas no association was observed in men (OR 1.01, 95% CI 0.73, 1.40, P = 0.951). Additionally, we found a significant association between per SD increase in TG level and an increased risk of osteoporotic fracture in total participants (OR 1.20, 95% CI 1.04, 1.38, P = 0.015). In women, a nonlinear relationship was observed between per SD increase in TG level and an increased risk of osteoporotic fracture. The risk of osteoporotic fracture in women increased with TG level >1.64 mmol/L (OR 1.93, 95% CI 1.24, 3.00, P = 0.004). CONCLUSION Among Chinese older adults, serum HDL-C level is significantly associated with a risk of osteoporotic fractures in women, and serum TG level is significantly associated with a risk of osteoporotic fractures in total participants and in women with TG >1.64 mmol/L.
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Affiliation(s)
- Yanmao Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiezhi Dai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Wanrun Zhong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chengfang Hu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Shengdi Lu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Shengdi Lu, ; Yimin Chai,
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Shengdi Lu, ; Yimin Chai,
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