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Okumura G, Yamamoto N, Suzuki H, Ninomiya H, Hirano Y, Tei Y, Tomiyama Y, Shimakura T, Takahashi HE, Imai N, Kawashima H. Histomorphometric analysis of patients with femoral neck fracture and 25-hydroxyvitamin D deficiency: a cross-sectional study. J Bone Miner Metab 2024; 42:214-222. [PMID: 38329506 DOI: 10.1007/s00774-024-01495-6] [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: 07/31/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Vitamin D deficiency causes osteoporosis, bone mineralization disorders, and osteomalacia. Osteomalacia is diagnosed using blood biochemical tests, clinical symptoms, and imaging; however, accurate detection of mineralization disorders requires tissue observation. We investigated the prevalence of bone mineralization disorders and their relationship with serum 25-hydroxyvitamin D (25OHD) levels in patients with untreated osteoporosis with femoral neck fractures. MATERIALS AND METHODS A non-demineralized specimen was prepared from the femoral head removed during surgery in 65 patients. Bone histomorphometry of cancerous bone in the femoral head center was conducted. Osteoid volume per bone volume (OV/BV) and osteoid thickness (O.Th) were measured as indicators of mineralization disorder. RESULTS The mean serum 25OHD level (11.9 ± 5.7 ng/mL) was in the deficiency range (< 12 ng/mL). There were no clinically diagnosed cases of osteomalacia (OV/BV > 10% and O.Th > 12.5 µm); however, one case of mineralization disorder, considered histologically pre-osteomalacia (OV/BV > 5% and O.Th < 12.5 µm), was observed (OB/BV, 17.6%; O.Th, 12.3 µm). Excluding this case, those with severe (25OHD < 12 ng/mL, at risk of osteomalacia; n = 39) and non-severe deficiency (25OHD ≥ 12 ng/mL; n = 25) did not significantly differ in OV/BV (%; 0.77 ± 0.54 vs. 0.69 ± 0.38, p = 0.484) or O.Th (µm; 5.32 ± 1.04 vs. 5.13 ± 0.78, p = 0.410). Further, 25OHD and OV/BV were not significantly correlated (R = - 0.124, p = 0.327). CONCLUSION This is the first study in the twenty-first century to examine serum 25OHD concentrations and bone mineralization disorders in Japanese patients with osteoporosis. The results indicate that vitamin D deficiency does not necessarily cause bone mineralization disorders and rarely leads to osteomalacia.
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Affiliation(s)
- Go Okumura
- Division of Orthopedic Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka City, 940-8621, Japan.
| | - Noriaki Yamamoto
- Division of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
- Niigata Bone Science Institute, Niigata, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka City, 940-8621, Japan
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Ninomiya
- Division of Orthopedic Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka City, 940-8621, Japan
| | - Yuki Hirano
- Division of Orthopedic Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka City, 940-8621, Japan
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshiaki Tei
- Division of Orthopedic Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka City, 940-8621, Japan
- Division of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Yasuyuki Tomiyama
- Division of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
- Division of Orthopedic Surgery, Niigata Prefectural Central Hospital, Niigata, Japan
| | | | | | - Norio Imai
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Choe H, Kobayashi N, Oba M, Tezuka T, Ike H, Morita A, Abe K, Inaba Y. Bilateral fragility femoral supracondylar fractures in adolescents due to long-term home stay during the COVID-19 pandemic: A case report. J Orthop Sci 2024; 29:405-408. [PMID: 35718603 PMCID: PMC9174151 DOI: 10.1016/j.jos.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masatoshi Oba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Akira Morita
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
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Nozaki A, Imai N, Shobugawa Y, Suzuki H, Horigome Y, Endo N, Kawashima H. Increased incidence among the very elderly in the 2020 Niigata Prefecture Osteoporotic Hip Fracture Study. J Bone Miner Metab 2023:10.1007/s00774-023-01421-2. [PMID: 36947240 PMCID: PMC10031707 DOI: 10.1007/s00774-023-01421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION A 2015 study showed a decreasing trend in the incidence of osteoporotic hip fractures in Niigata Prefecture, Japan, which had been increasing. This study aimed to investigate the incidence of osteoporotic hip fractures in 2020, determine the long-term change in the incidence of hip fractures from 1985 to 2020, and assess whether the decline in fracture incidence since 2010 has continued. MATERIALS AND METHODS We obtained data from the registration forms submitted by hospitals and clinics of patients who lived in Niigata Prefecture and were diagnosed with osteoporotic hip fracture through a survey conducted from January 1, 2020 to December 31, 2020. RESULTS In 2020, 3,369 hip fractures were recorded in Niigata Prefecture. Although the overall incidence of age-specific hip fractures decreased, it increased in patients aged ≥ 90 years, regardless of sex. The proportion of patients receiving anti-osteoporosis drugs prior to hip fracture increased from 7.6% in 2004 to 17.3% in 2020. Notably, surgical treatment should be performed as early as possible, and the preoperative waiting time was 2.9 days, which was mainly due to holidays. CONCLUSION The incidence of hip fractures in Niigata Prefecture has gradually increased over the past 35 years, with an increasing change observed in the very elderly recently in 2020. Although the treatment of osteoporotic hip fractures in Niigata Prefecture is adequate, improvements may include increasing the rate of adoption of osteoporosis treatment further and decreasing the number of days of preoperative waiting.
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Affiliation(s)
- Asami Nozaki
- Division of Orthopedic Surgery Department of Regenerative and Transplant Medicine, School of Medical and Dental Sciences, Niigata University Graduate, Niigata City, Niigata Prefecture, Japan
| | - Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata Prefecture, 951-8510, Japan.
| | - Yugo Shobugawa
- Division of International Health, School of Medical and Dental Sciences, Niigata University Graduate, Niigata City, Niigata Prefecture, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery Department of Regenerative and Transplant Medicine, School of Medical and Dental Sciences, Niigata University Graduate, Niigata City, Niigata Prefecture, Japan
| | - Yoji Horigome
- Division of Orthopedic Surgery Department of Regenerative and Transplant Medicine, School of Medical and Dental Sciences, Niigata University Graduate, Niigata City, Niigata Prefecture, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata Tsubame Rosai Hospital, Tsubane City, Niigata Prefecture, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery Department of Regenerative and Transplant Medicine, School of Medical and Dental Sciences, Niigata University Graduate, Niigata City, Niigata Prefecture, Japan
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Hata R, Miyamoto K, Abe Y, Sasaki T, Oguma Y, Tajima T, Arai Y, Matsumoto M, Nakamura M, Kanaji A, Miyamoto T. Osteoporosis and sarcopenia are associated with each other and reduced IGF1 levels are a risk for both diseases in the very old elderly. Bone 2023; 166:116570. [PMID: 36182103 DOI: 10.1016/j.bone.2022.116570] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
It is mandatory to manage musculoskeletal disorders in the elderly to prevent their becoming bed-ridden or requiring long-term care. However, the prevalence of musculoskeletal disorders such as osteoporosis and sarcopenia in otherwise healthy people over 85 years old is not completely known. Here we enrolled 1026 healthy subjects between 85 and 89 years old and evaluated them for the presence of osteoporosis, sarcopenia and fragility fracture(s), and how those conditions were related. We also evaluated biomarkers such as serum levels of insulin-like growth factor 1 (IGF1) and vitamin D status. The prevalence of osteoporosis, sarcopenia or fragility fracture(s) in these subjects was 22.4, 10.2 or 15.0 %, respectively. Serum IGF1 and 25(OH)D were significantly and negatively correlated with osteoporosis or sarcopenia. Osteoporosis and either sarcopenia or fragility fracture(s) were significantly related and shown to be risk factors for each other, even after adjustment for gender and BMI, while sarcopenia and fragility fracture(s) were not associated. Our data may provide a health platform for the very elderly and suggest strategies to prevent musculoskeletal disorders in this population.
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Affiliation(s)
- Ryosuke Hata
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yukiko Abe
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takashi Sasaki
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuko Oguma
- Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan; Graduate School of Health Management, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan
| | - Takayuki Tajima
- Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-0061, Japan; Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Yasumichi Arai
- Centre for Supercentenarian Medical Research, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Faculty of Nursing and Medical Care, Keio University, 5322 Endo, Fujisawa, Kanagawa 252-0882, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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Maier GS, Weissenberger M, Rudert M, Roth KE, Horas K. The role of vitamin D and vitamin D deficiency in orthopaedics and traumatology-a narrative overview of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:942. [PMID: 34350257 PMCID: PMC8263860 DOI: 10.21037/atm-21-779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022]
Abstract
Vitamin D is considered to play an important role in musculoskeletal health. It’s classical function is the regulation of calcium and phosphate homeostasis, thus ensuring a balanced bone metabolism that is characterised by an equal amount of bone resorption and bone formation. In the past decades, a plethora of pre-clinical and clinical studies reporting on potential health-beneficial properties of vitamin D have emerged. Moreover, there is an abundance of reports highlighting vitamin D deficiency and insufficiency in patients with almost innumerable diseases. Further, it is estimated that more than one billion people globally are affected by insufficient vitamin D levels. As such, research on vitamin D has been particularly popular over the past years. In orthopaedics and traumatology, most studies describe favourable effects of vitamin D in general. However, the relative importance of vitamin D is oftentimes debated. In this narrative review of the literature, we consider first, the properties of vitamin D and how vitamin D, vitamin D deficiency and the vitamin D receptor (VDR) impact on musculoskeletal health. Secondly, we provide an overview of studies reporting the prevalence of vitamin D deficiency in traumatology and diverse orthopaedic diseases including bone oncology. Lastly, we emphasise recent findings and touch on future perspectives in vitamin D research.
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Affiliation(s)
- Gerrit S Maier
- Rehazentrum am Meer, Bad Zwischenahn, Germany.,Department of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg, Germany
| | - Manuel Weissenberger
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany
| | - Klaus E Roth
- Department of Orthopaedic Surgery and Joint Academy, Gelenkzentrum Rhein-Main, Hochheim, Germany
| | - Konstantin Horas
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany.,Bernhard-Heine Centre for Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
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6
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Patel VV, Wuthrich ZR, Ortega A, Ferguson VL, Lindley EM. Recombinant Human Bone Morphogenetic Protein-2 Improves Spine Fusion in a Vitamin D-Deficient Rat Model. Int J Spine Surg 2020; 14:694-705. [PMID: 33077435 DOI: 10.14444/7101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The effects of vitamin D deficiency on spinal fusion are not well studied, nor are approaches to overcoming deficiency-related detrimental effects. The purpose of this study was to (1) evaluate the effects of vitamin D deficiency on spine fusion in a rat model, and (2) determine whether recombinant human bone morphogenetic protein-2 (rhBMP-2) can improve outcomes in deficient rats. METHODS Sprague-Dawley rats were assigned to a vitamin D group: vitamin D sufficient (14), vitamin D deficient (16), vitamin D postoperative rescue (15). Posterolateral fusion was performed at L3-4 and L5-6, with one level receiving rhBMP-2 and the other allograft. Following 6 weeks, the spines were harvested for micro-computed tomography (micro-CT) and histological analyses. Fusion was assessed via manual palpation and micro-CT assessment. Micro-CT images were analyzed for bone microarchitecture in intact L5 vertebral bodies and within fused bone masses treated with rhBMP-2. RESULTS There were no significant effects of vitamin D status on fusion assessments. However, the microarchitecture of native bone in the intact L5 vertebral bodies of vitamin D-sufficient rats showed significantly greater trabecular thickness (P < .001) and bone volume fraction (P < .001), with decreased trabecular spacing (P < .001), than that of vitamin D-deficient rats. Fusion masses of rhBMP-2 levels also showed significant effects of vitamin D supplementation on both bone volume fraction and trabecular thickness. Histological analysis confirmed that robust bone formation was observed in rhBMP-2-treated fusions, but not in fusion levels treated with allograft. CONCLUSIONS Overall, vitamin D deficiency decreased trabecular bone microarchitecture, and treatment with rhBMP-2 improved outcomes across all vitamin D groups. CLINICAL RELEVANCE Given the prevalence of vitamin D deficiency in spine surgery patients, vitamin D supplementation may be a cost-effective method for reducing the risk of pseudoarthrosis.
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Affiliation(s)
- Vikas V Patel
- Department of Orthopedics, Divisions of Spine Surgery and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Zachary R Wuthrich
- Department of Orthopedics, Divisions of Spine Surgery and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alicia Ortega
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado
| | - Virginia L Ferguson
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado
| | - Emily M Lindley
- Department of Orthopedics, Divisions of Spine Surgery and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Niikura T, Oe K, Sakai Y, Iwakura T, Fukui T, Nishimoto H, Hayashi S, Matsumoto T, Matsushita T, Maruo A, Yagata Y, Kishimoto K, Sakurai A, Kuroda R. Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population. J Orthop Surg (Hong Kong) 2020; 27:2309499019877517. [PMID: 31554468 DOI: 10.1177/2309499019877517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population. METHODS Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures. RESULTS The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D <30 ng/mL) and deficiency (25(OH)D <20 ng/mL) was 93.9% and 71.7%, respectively. A significant difference was noted in the prevalence of vitamin D deficiency between patients with and without previous contralateral hip fractures. Age and 25(OH)D levels were found to be correlated, with no correlation between the UV index and the 25(OH)D levels. The 25(OH)D level in the younger population (n = 123) was 20.7 ± 8.6 ng/mL, which was significantly higher than that of the elderly. CONCLUSION Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.
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Affiliation(s)
- Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Iwakura
- Department of Orthopaedic Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Yukihisa Yagata
- Department of Orthopaedic Surgery, Hyogo Emergency Medical Center, Kobe, Japan
| | - Kenta Kishimoto
- Department of Orthopaedic Surgery, Hyogo Prefectural Kakogawa Medical Center, Kobe, Japan
| | - Atsushi Sakurai
- Department of Orthopaedic Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Sakuma M, Kitamura K, Endo N, Ikeuchi T, Yokoseki A, Onodera O, Oinuma T, Momotsu T, Sato K, Nakamura K, Narita I. Low serum 25-hydroxyvitamin D increases cognitive impairment in elderly people. J Bone Miner Metab 2019; 37:368-375. [PMID: 29948345 DOI: 10.1007/s00774-018-0934-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
Abstract
It has been reported that many elderly people have low serum levels of 25-hydroxyvitamin D [25(OH)D] and that serum 25(OH)D levels may have a relationship with cognitive function. The aim of this study was to examine the relationship between serum 25(OH)D levels and cognitive function in a Japanese population. This cross-sectional study was performed as a part of the Project in Sado for Total Health (PROST). The PROST study evaluated cognitive state and serum vitamin D level from June 2011 to November 2013 for 740 patients (431 men and 309 women). The Mini-Mental State Examination-Japanese version (MMSE-J) and serum 25(OH)D level measurements were used as assessment tools. Cognitive impairment was defined using MMSE-J ≤ 23 as a cutoff. Multiple logistic regression analyses were performed to calculate the odds ratios (ORs) for low MMSE-J scores. The average subject age was 68.1 years, the average MMSE- J score was 25.9, and the average 25(OH)D level was 24.6 ng/mL. Significant ORs for cognitive impairment were observed for both high age and low serum 25(OH)D. The adjusted OR for the lowest versus highest serum 25(OH)D quartiles was 2.70 (95% confidence interval 1.38-5.28, P = 0.0110). Low serum 25(OH)D levels were independently associated with a higher prevalence of cognitive impairment.
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Affiliation(s)
- Mayumi Sakuma
- Department of Physical Therapy, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan.
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kaori Kitamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akio Yokoseki
- Center for Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Osamu Onodera
- Department of Molecular Neuroscience, Resource Branch for Brain Disease Research, Brain Research Institute, Niigata University, Niigata, Japan
| | | | | | | | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Imai N, Endo N, Shobugawa Y, Ibuchi S, Suzuki H, Miyasaka D, Sakuma M. A decrease in the number and incidence of osteoporotic hip fractures among elderly individuals in Niigata, Japan, from 2010 to 2015. J Bone Miner Metab 2018; 36:573-579. [PMID: 28884394 DOI: 10.1007/s00774-017-0863-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Abstract
We investigated the incidence of hip fracture in patients aged ≥50 years in 2015 in Niigata Prefecture, Japan. We also determined the long-term trend in hip fracture incidence from 1985 to 2015. In 2015, 3214 hip fractures occurred in Niigata Prefecture. The crude incidence rate of hip fracture was 282.7 per 100,000 persons per year (122.9 in men and 416.4 in women). The incidence of hip fracture decreased from 2010 to 2015 in all age groups except in men aged 65-69 years and women aged 60-64 years. The percentage of patients who took anti-osteoporotic medication before their hip fractures increased from 10.2% in 2010 to 14.9% in 2015. The age-specific incidence in women tended to increase until 2010, but significantly decreased from 2010 to 2015 (p < 0.001). Similarly, the incidence in men decreased from 2010 to 2015 but was not significantly different from that in 1994 (p = 0.633); this incidence had been increasing since 1999. In conclusion, a generally increasing trend was observed in the incidence of hip fractures for 30 years in both men and women in Niigata Prefecture; however, it turned into a descending trend beginning in 2010.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan.
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan.
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan
| | - Yugo Shobugawa
- Division of International Health, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan
| | - Shinya Ibuchi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan
| | - Dai Miyasaka
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata, Niigata, 9518510, Japan
| | - Mayumi Sakuma
- Department of Physical Therapy, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 Shimamicho, Niigata, Niigata, 9503198, Japan
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10
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Aoki K, Sakuma M, Endo N. The impact of exercise and vitamin D supplementation on physical function in community-dwelling elderly individuals: A randomized trial. J Orthop Sci 2018; 23:682-687. [PMID: 29705177 DOI: 10.1016/j.jos.2018.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND We investigated the impact of exercise and vitamin D supplementation on physical function and locomotor dysfunction in community-dwelling elderly individuals. METHODS In total, 148 community-dwelling elderly individuals (aged ≥60 years) who were not taking osteoporosis medications participated in a 24-week intervention. The participants were randomly divided into an exercise group, vitamin D group, and exercise and vitamin D group. The participants and outcome-assessing staff were not blinded to group assignment. Exercise comprised three daily sets each of single-leg standing (1 min/leg/set) and squatting (5-6 repetitions/set); vitamin D supplementation was 1000 IU/day. Participants were contacted every 2 weeks to check on their condition and encourage continued participation. The primary outcome was lower limb muscle strength and mass; secondary outcomes were several physical function measurements, serum 25-hydroxyvitamin D levels, and results of a self-assessment questionnaire completed pre- and post-intervention. RESULTS We analyzed data from 45, 42, and 43 participants in the exercise, vitamin D, and exercise and vitamin D groups, respectively, who completed the intervention. Locomotive syndrome, which involves reduced mobility due to locomotive organ impairment, was diagnosed in 99 participants (76.2%). Many physical function measurements improved in all groups. Lower limb muscle mass increased significantly in all three groups, with no significant differences between the groups in the degree of change. The average serum 25-hydroxyvitamin D of all vitamin D-supplemented participants increased from 28.1 ng/ml to 47.3 ng/ml after vitamin D supplementation. CONCLUSIONS Both exercise and vitamin D supplementation independently improved physical function and increased muscle mass in community-dwelling elderly individuals. Moreover, the combination of exercise and vitamin D supplementation might further enhance these positive effects. CLINICAL TRIAL REGISTRY UMIN Clinical Trial, UMIN000028229.
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Affiliation(s)
- Kana Aoki
- Department of Rehabilitation, Niigata Nishikan Medical Center Hospital, 4368, Maki-Kou, Nishikan-Ku, Niigata City, Niigata, 953-0041, Japan; Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori Chuo-Ku, Niigata City, Niigata, 951-8510, Japan.
| | - Mayumi Sakuma
- Department of Physical Therapy, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398, Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Naoto Endo
- Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori Chuo-Ku, Niigata City, Niigata, 951-8510, Japan
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11
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Okazaki R, Ozono K, Fukumoto S, Inoue D, Yamauchi M, Minagawa M, Michigami T, Takeuchi Y, Matsumoto T, Sugimoto T. Assessment criteria for vitamin D deficiency/insufficiency in Japan - proposal by an expert panel supported by Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]. Endocr J 2017; 64:1-6. [PMID: 28003569 DOI: 10.1507/endocrj.ej16-0548] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vitamin D is indispensable for the maintenance of bone and mineral health. Inadequate vitamin D action increases the risk for various musculoskeletal/mineral events including fracture, fall, secondary hyperparathyroidism, diminished response to antiresorptives, rickets/osteomalacia, and hypocalcemia. Its most common cause in recent years is vitamin D deficiency/insufficiency, clinically defined by low serum 25-hydroxyvitamin D [25(OH)D] level. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published all over the world. In Japan, however, the information on the associations between serum 25(OH)D and bone and mineral disorders has not been widely shared among healthcare providers, partly because its measurement had not been reimbursed with national medical insurance policy until August 2016. We have set out to collect and analyze Japanese data on the relationship between serum 25(OH)D concentration and bone and mineral events. Integrating these domestic data and published guidelines worldwide, here we present the following assessment criteria for vitamin D sufficiency/insufficiency/deficiency using serum 25(OH)D level in Japan. 1) Serum 25(OH)D level equal to or above 30 ng/mL is considered to be vitamin D sufficient. 2) Serum 25(OH)D level less than 30 ng/mL but not less than 20 ng/mL is considered to be vitamin D insufficient. 3) Serum 25(OH)D level less than 20 ng/mL is considered to be vitamin D deficient. We believe that these criteria will be clinically helpful in the assessment of serum 25(OH)D concentrations and further expect that they will form a basis for the future development of guidelines for the management of vitamin D deficiency/insufficiency.
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Affiliation(s)
- Ryo Okazaki
- Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara 299-0111, Japan
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12
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Okazaki R, Ozono K, Fukumoto S, Inoue D, Yamauchi M, Minagawa M, Michigami T, Takeuchi Y, Matsumoto T, Sugimoto T. Assessment criteria for vitamin D deficiency/insufficiency in Japan: proposal by an expert panel supported by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research and the Japan Endocrine Society [Opinion]. J Bone Miner Metab 2017; 35:1-5. [PMID: 27882481 DOI: 10.1007/s00774-016-0805-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Vitamin D is indispensable for the maintenance of bone and mineral health. Inadequate vitamin D action increases the risk for various musculoskeletal/mineral events including fracture, fall, secondary hyperparathyroidism, diminished response to antiresorptives, rickets/osteomalacia, and hypocalcemia. Its most common cause in recent years is vitamin D deficiency/insufficiency, clinically defined by a low serum 25-hydroxyvitamin D [25(OH)D] level. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published all over the world. In Japan, however, the information on the associations between serum 25(OH)D and bone and mineral disorders has not been widely shared among healthcare providers, partly because its measurement had not been reimbursed with national medical insurance policy until August 2016. We have set out to collect and analyze Japanese data on the relationship between serum 25(OH)D concentration and bone and mineral events. Integrating these domestic data and published guidelines worldwide, here, we present the following assessment criteria for vitamin D sufficiency/insufficiency/deficiency using serum 25(OH)D level in Japan. (1) Serum 25(OH)D level equal to or above 30 ng/ml is considered to be vitamin D sufficient. (2) Serum 25(OH)D level less than 30 ng/ml but not less than 20 ng/ml is considered to be vitamin D insufficient. (3) Serum 25(OH)D level less than 20 ng/ml is considered to be vitamin D deficient. We believe that these criteria will be clinically helpful in the assessment of serum 25(OH)D concentrations and further expect that they will form a basis for the future development of guidelines for the management of vitamin D deficiency/insufficiency.
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Affiliation(s)
- Ryo Okazaki
- Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, 299-0111, Japan.
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
| | - Seiji Fukumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, 770-8503, Japan
| | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, 299-0111, Japan
| | - Mika Yamauchi
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, 693-8501, Japan
| | - Masanori Minagawa
- Department of Endocrinology, Chiba Children's Hospital, Chiba, 266-0007, Japan
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Research Institute, Osaka Medical Center for Maternal and Child Health, Izumi, 594-1101, Japan
| | - Yasuhiro Takeuchi
- Division of Endocrinology, Toranomon Hospital Endocrine Center, Tokyo, 105-8470, Japan
| | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, 770-8503, Japan
| | - Toshitsugu Sugimoto
- Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, 693-8501, Japan
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Endo N. Osteoporosis as a Cause of Locomotive Syndrome: The Influence on Functional Mobility and Activities of Daily Living. Clin Rev Bone Miner Metab 2016. [DOI: 10.1007/s12018-016-9215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Takada J, Ikeda S, Kusanagi T, Mizuno S, Wada H, Iba K, Yoshizaki T, Yamashita T. Comparison of the effects of eldecalcitol with either raloxifene or bisphosphonate on serum tartrate resistant acid phosphatase-5b, a bone resorption marker, in postmenopausal osteoporosis. ACTA ACUST UNITED AC 2016; 13:25-8. [PMID: 27252739 DOI: 10.11138/ccmbm/2016.13.1.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study analyzes whether concomitant raloxifene (RLX) or bisphosphonates (BP) plus eldecalcitol (ELD) has excessive suppressive effects on a bone resorption marker during the first 6 months of treatment in postmenopausal women in real-world setting. METHODS 285 postmenopausal osteoporotic patients who had been treated with RLX or BP plus ELD were evaluated the bone resorption marker, serum tartrate resistant acid phosphatase-5b (TRACP-5b), during the first 6 months of treatment. RESULTS In drug-naïve group (not received osteoporosis medications before the administration, n=70), the concomitant RLX or BP with ELD significantly decreased levels of TRACP-5b without severe suppression. In vitamin D switch group [RLX or BP plus alfacalcidol (ALF) and then switched to RLX or BP plus ELD, n=215], the replacing ALF with ELD further and significantly decreased TRACP-5b and tertile analyses based on baseline values were significantly decreased far more in the highest, compared with the lowest tertile in the ELD+RLX and ELD+BP groups. CONCLUSION ELD combined with RLX or BP administered for 6 months to postmenopausal women with osteoporosis who were drug-naïve or who had switched medications significantly reduced and maintained TRACP-5b values within the reference range.
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Affiliation(s)
| | - Satoshi Ikeda
- Department of Orthopaedic Surgery, Ken-Ai Memorial Hospital, Onga cho Fukuoka, Japan
| | | | | | | | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | | | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
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15
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Vitamin D Deficiency with High Intact PTH Levels is More Common in Younger than in Older Women: A Study of Women Aged 39-64 Years. Keio J Med 2016; 65:33-8. [PMID: 26853879 DOI: 10.2302/kjm.2015-0010-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Low serum 25-hydroxyvitamin D (25(OH)D) levels are implicated as a risk factor for hip and spine fractures. Studies of the relation between 25(OH)D levels and fractures have primarily involved elderly osteoporosis patients or patients with fractures; however, the serum 25(OH)D and parathyroid hormone (PTH) status in younger adult populations remains largely unknown. We evaluated serum 25(OH)D and intact PTH levels in 411 women aged 39-64 years who were not receiving medication for osteoporosis or other bone diseases. Serum 25(OH)D levels were positively correlated with age (P = 0.019), whereas intact PTH levels were inversely correlated with 25(OH)D levels (P < 0.001). Thus, low vitamin D levels with high intact PTH levels were more common in younger than in older women. Our data show that serum 25(OH)D insufficiency could be a more serious concern in the younger population than had been previously anticipated. Because serum 25(OH)D insufficiency is reportedly a risk factor for hip and spine fracture, the number of fracture patients could increase in the future, suggesting that we may need to correct the serum vitamin D/intact PTH status to prevent future osteoporosis.
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16
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Sprague S, Petrisor B, Scott T, Devji T, Phillips M, Spurr H, Bhandari M, Slobogean GP. What Is the Role of Vitamin D Supplementation in Acute Fracture Patients? A Systematic Review and Meta-Analysis of the Prevalence of Hypovitaminosis D and Supplementation Efficacy. J Orthop Trauma 2016; 30:53-63. [PMID: 26429406 DOI: 10.1097/bot.0000000000000455] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objectives of this systematic review and meta-analyses are (1) to estimate the prevalence of hypovitaminosis D in fracture patients and (2) to summarize the available evidence on the efficacy of vitamin D supplementation in fracture patients. DATA SOURCES A comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases was conducted. Conference abstracts from relevant meetings were also searched. STUDY SELECTION We included studies that investigate vitamin D insufficiency or examine the effect of vitamin D supplementation on 25-hydroxy-vitamin D (25(OH)D) serum levels in fracture patients. DATA EXTRACTION Two authors independently extracted data using a predesigned form. DATA SYNTHESIS We performed a pooled analysis to determine the prevalence of postfracture hypovitaminosis D and mean postfracture 25(OH)D levels. We present detailed summaries of each of the studies evaluating the impact of vitamin D supplementation. RESULTS The weighted pooled prevalence of hypovitaminosis D was 70.0% (95% confidence interval: 63.7%-76.0%, I = 97.7). The mean postfracture serum 25(OH)D was 19.5 ng/mL. The studies that evaluated the efficacy of vitamin D supplementation suggest that vitamin D supplementation safely increases serum 25(OH)D levels. Only 1 meeting abstract showed a trend toward reduced risk of nonunion after a single large loading dose of vitamin D. CONCLUSIONS This review found a high prevalence of hypovitaminosis D in fracture patients and that vitamin D supplementation at a range of doses safely increases 25(OH)D serum levels. To date, only 1 pilot study published as a meeting abstract has demonstrated a trend toward improved fracture healing with vitamin D supplementation. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sheila Sprague
- *Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada;†Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;‡Graduate Entry Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; and§Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
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17
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Miyasaka D, Endo N, Endo E, Sakuma M, Yamamoto N, Tanabe N, Imai N, Suda K. Incidence of hip fracture in Niigata, Japan in 2004 and 2010 and the long-term trends from 1985 to 2010. J Bone Miner Metab 2016; 34:92-8. [PMID: 25773048 DOI: 10.1007/s00774-015-0648-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
We investigated the incidence of hip fracture in a population of patients ≥50 years old in 2004 and 2010 in Niigata City, Niigata Prefecture, Japan. We also investigated the long-term trends in the incidence of hip fracture from 1985 to 2010, using our previously reported survey results obtained from 1985 to 1999. In 2004 and 2010, the survey found 2,368 and 3,218 proximal femur fractures, respectively. The crude hip fracture incidence rates in 2004 and 2010 were 215.8 and 281.5 per 100,000 of population per year, respectively. For males, the incidence rates were 99.9 in 2004 and 126.3 in 2010; for females, the incidence rates were 311.0 and 410.7, respectively. In males aged 80-84 years, the incidence rate since 1999 has been decreasing, while that for males >85 years peaked in 2004. In females of all ages, the incidence rate was higher in 2010 than in all other survey periods, and in females >85 years, the incidence has increased the fastest. Additionally, the long-term changes in the age- and sex-standardized incidence each year using the 1985 population structure in Japan in females has been increasing, although it decreased in 1999. However, in males, the incidence in 2010 was not significantly different from that in 1994, although it has been increasing since 1999. Our study findings indicate that the age-specific incidence of hip fractures in the Niigata Prefecture of Japan has not plateaued in females, but that it may have done so in males; in addition, the number and incidence of hip fractures has been increasing.
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Affiliation(s)
- Dai Miyasaka
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, 951-8510, Japan.
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, 951-8510, Japan
| | - Einosuke Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, 951-8510, Japan
| | - Mayumi Sakuma
- Department of Physical Therapy, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, 950-3198, Japan
| | - Noriaki Yamamoto
- Division of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Niigata, 950-3304, Japan
| | - Naohito Tanabe
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, 951-8510, Japan
| | - Norio Imai
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, 951-8510, Japan
| | - Ken Suda
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, 951-8510, Japan
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18
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Vitamin D deficiency in adult fracture patients: prevalence and risk factors. Eur J Trauma Emerg Surg 2015; 42:369-78. [PMID: 26194498 PMCID: PMC4886150 DOI: 10.1007/s00068-015-0550-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/26/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Although vitamin D levels are not routinely monitored in outpatient fracture patients, identification of fracture patients with a deficient vitamin D status may be clinically relevant because of the potential role of vitamin D in fracture healing. This study aimed to determine the prevalence of and risk factors for vitamin D deficiency in non-operatively treated adult fracture patients. PATIENTS AND METHODS Vitamin D levels were determined in a cross-sectional study of adult patients, who were treated non-operatively for a fracture of the upper or lower extremity in the outpatient clinic of a level 1 trauma center, during one calendar year. Potential risk factors for (severe) vitamin D deficiency were analyzed using multivariable logistic regression analysis. RESULTS A total of 208 men and 319 women with a mean age of 49.7 years (SD 19.9) were included. In this population, 71 % had a serum calcidiol <75 nmol/L, 40 % were vitamin D deficient (serum calcidiol <50 nmol/L) and 11 % were severely vitamin D deficient (serum calcidiol <25 nmol/L). Smoking and season (winter and spring) were independent risk factors for vitamin D deficiency. An increasing age, a non-Caucasian skin type, winter and smoking were identified as independent risk factors for severe vitamin D deficiency. The use of vitamin D, alcohol consumption and higher average daily sun exposure were independent protective factors against (severe) vitamin D deficiency. CONCLUSION Given the potential role of vitamin D in fracture healing, clinicians treating adult fracture patients should be aware of the frequent presence of vitamin D deficiency during the winter, especially in smoking and non-Caucasian patients. Research on the effect of vitamin D deficiency or supplementation on fracture healing is needed, before suggesting routine monitoring or supplementation.
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Hao W, Tashiro S, Hasegawa T, Sato Y, Kobayashi T, Tando T, Katsuyama E, Fujie A, Watanabe R, Morita M, Miyamoto K, Morioka H, Nakamura M, Matsumoto M, Amizuka N, Toyama Y, Miyamoto T. Hyperglycemia Promotes Schwann Cell De-differentiation and De-myelination via Sorbitol Accumulation and Igf1 Protein Down-regulation. J Biol Chem 2015; 290:17106-15. [PMID: 25998127 DOI: 10.1074/jbc.m114.631291] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 01/20/2023] Open
Abstract
Diabetes mellitus (DM) is frequently accompanied by complications, such as peripheral nerve neuropathy. Schwann cells play a pivotal role in regulating peripheral nerve function and conduction velocity; however, changes in Schwann cell differentiation status in DM are not fully understood. Here, we report that Schwann cells de-differentiate into immature cells under hyperglycemic conditions as a result of sorbitol accumulation and decreased Igf1 expression in those cells. We found that de-differentiated Schwann cells could be re-differentiated in vitro into mature cells by treatment with an aldose reductase inhibitor, to reduce sorbitol levels, or with vitamin D3, to elevate Igf1 expression. In vivo DM models exhibited significantly reduced nerve function and conduction, Schwann cell de-differentiation, peripheral nerve de-myelination, and all conditions were significantly rescued by aldose reductase inhibitor or vitamin D3 administration. These findings reveal mechanisms underlying pathological changes in Schwann cells seen in DM and suggest ways to treat neurological conditions associated with this condition.
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Affiliation(s)
- Wu Hao
- From the Departments of Orthopedic Surgery
| | | | - Tomoka Hasegawa
- the Department of Developmental Biology of Hard Tissue, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586, Japan
| | - Yuiko Sato
- From the Departments of Orthopedic Surgery, Musculoskeletal Reconstruction and Regeneration Surgery
| | - Tami Kobayashi
- From the Departments of Orthopedic Surgery, Integrated Bone Metabolism and Immunology, and
| | | | | | | | | | - Mayu Morita
- Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582 and
| | | | | | | | | | - Norio Amizuka
- the Department of Developmental Biology of Hard Tissue, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586, Japan
| | | | - Takeshi Miyamoto
- From the Departments of Orthopedic Surgery, Integrated Bone Metabolism and Immunology, and
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20
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Maier GS, Seeger JB, Horas K, Roth KE, Kurth AA, Maus U. The prevalence of vitamin D deficiency in patients with vertebral fragility fractures. Bone Joint J 2015; 97-B:89-93. [DOI: 10.1302/0301-620x.97b1.34558] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypovitaminosis D has been identified as a common risk factor for fragility fractures and poor fracture healing. Epidemiological data on vitamin D deficiency have been gathered in various populations, but the association between vertebral fragility fractures and hypovitaminosis D, especially in males, remains unclear. The purpose of this study was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in patients presenting with vertebral fragility fractures and to determine whether patients with a vertebral fracture were at greater risk of hypovitaminosis D than a control population. Furthermore, we studied the seasonal variations in the serum vitamin D levels of tested patients in order to clarify the relationship between other known risk factors for osteoporosis and vitamin D levels. We measured the serum 25-OH D levels of 246 patients admitted with vertebral fractures (105 men, 141 female, mean age 69 years, sd 8.5), and in 392 orthopaedic patients with back pain and no fractures (219 men, 173 female, mean age 63 years, sd 11) to evaluate the prevalence of vitamin D insufficiency. Statistical analysis found a significant difference in vitamin D levels between patients with vertebral fragility fracture and the control group (p = 0.036). In addition, there was a significant main effect of the tested variables: obesity (p < 0.001), nicotine abuse (p = 0.002) and diabetes mellitus (p < 0.001). No statistical difference was found between vitamin D levels and gender (p = 0.34). Vitamin D insufficiency was shown to be a risk factor for vertebral fragility fractures in both men and women. Cite this article: Bone Joint J 2015;97-B:89–93.
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Affiliation(s)
| | | | - K. Horas
- ANZAC Research Institute , University
of Sydney, Australia
| | - K. E. Roth
- Johannes-Gutenberg-University, Mainz, Germany
| | - A. A. Kurth
- Themistocles Gluck Hospital, Ratingen, Germany
| | - U. Maus
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Oldenburg, Germany
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21
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Sato Y, Miyauchi Y, Yoshida S, Morita M, Kobayashi T, Kanagawa H, Katsuyama E, Fujie A, Hao W, Tando T, Watanabe R, Miyamoto K, Morioka H, Matsumoto M, Toyama Y, Miyamoto T. The vitamin D analogue ED71 but Not 1,25(OH)2D3 targets HIF1α protein in osteoclasts. PLoS One 2014; 9:e111845. [PMID: 25375896 PMCID: PMC4222951 DOI: 10.1371/journal.pone.0111845] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022] Open
Abstract
Although both an active form of the vitamin D metabolite, 1,25(OH)2D3, and the vitamin D analogue, ED71 have been used to treat osteoporosis, anti-bone resorbing activity is reportedly seen only in ED71- but not in 1,25(OH)2D3 -treated patients. In addition, how ED71 inhibits osteoclast activity in patients has not been fully characterized. Recently, HIF1α expression in osteoclasts was demonstrated to be required for development of post-menopausal osteoporosis. Here we show that ED71 but not 1,25(OH)2D3, suppress HIF1α protein expression in osteoclasts in vitro. We found that 1,25(OH)2D3 or ED71 function in osteoclasts requires the vitamin D receptor (VDR). ED71 was significantly less effective in inhibiting M-CSF and RANKL-stimulated osteoclastogenesis than was 1,25(OH)2D3in vitro. Downregulation of c-Fos protein and induction of Ifnβ mRNA in osteoclasts, both of which reportedly block osteoclastogenesis induced by 1,25(OH)2D3in vitro, were both significantly higher following treatment with 1,25(OH)2D3 than with ED71. Thus, suppression of HIF1α protein activity in osteoclasts in vitro, which is more efficiently achieved by ED71 rather than by 1,25(OH)2D3, could be a reliable read-out in either developing or screening reagents targeting osteoporosis.
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Affiliation(s)
- Yuiko Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshiteru Miyauchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shigeyuki Yoshida
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mayu Morita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tami Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Integrated Bone Metabolism and Immunology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroya Kanagawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eri Katsuyama
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Atsuhiro Fujie
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Wu Hao
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshimi Tando
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ryuichi Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Department of Integrated Bone Metabolism and Immunology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- * E-mail:
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Hagino H, Takano T, Fukunaga M, Shiraki M, Nakamura T, Matsumoto T. Eldecalcitol reduces the risk of severe vertebral fractures and improves the health-related quality of life in patients with osteoporosis. J Bone Miner Metab 2013; 31:183-9. [PMID: 23129180 PMCID: PMC3590407 DOI: 10.1007/s00774-012-0397-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Abstract
Eldecalcitol reduces the risk of vertebral fractures in comparison to alfacalcidol in osteoporotic patients under vitamin D repletion. The aim of this study was to evaluate the effects of eldecalcitol on the spinal location of incident vertebral fractures, the severity of the fractures, and the changes in health-related quality of life (HRQOL) compared with those of alfacalcidol. The post hoc analysis has been performed on the data from the three-year, double-blind, randomized, head-to-head clinical trial of eldecalcitol versus alfacalcidol conducted in Japan. A total of 1054 patients were enrolled and randomized to take 0.75 μg eldecalcitol or 1.0 μg alfacalcidol daily for 3 years. The incidence of vertebral fractures was re-evaluated based on the location on the spine (upper T4-T10; lower T11-L4). The severity of vertebral fractures was determined by the semi-quantitative method, and the change in HRQOL was analyzed by using the Medical Outcomes Study Short Form 36-item questionnaire. The incidence of vertebral fracture at the lower spine was less in the eldecalcitol group than in the alfacalcidol group (p = 0.029). The incidence of severe vertebral fracture (Grade 3) was 3.8 % in the eldecalcitol group and 6.7 % in the alfacalcidol group, demonstrated a significant difference between the 2 groups (p = 0.036). Both eldecalcitol and alfacalcidol improved HRQOL in osteoporotic patients. Although no significant differences in each HRQOL scores were observed between eldecalcitol and alfacalcidol during the observational period, overall improvement from baseline of HRQOL scores were clearly observed in the eldecalcitol group. In conclusion, the incidences of lower spinal vertebral fractures and severe vertebral fractures were reduced further by eldecalcitol compared to alfacalcidol in the 3-year clinical trial. Daily treatment with eldecalcitol is effective in improving HRQOL, possibly owing to the reduced risk of lower spinal vertebral fractures and/or severe vertebral fractures.
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Affiliation(s)
- Hiroshi Hagino
- School of Health Science, Tottori University, 86 Nishi-Cho, Yonago, Tottori, 683-8503, Japan.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318256e7f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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