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Hershkovitz A, Maydan G, Ben Joseph R, Nissan R. Vitamin D levels in post-acute hip fractured patients and their association with rehabilitation outcomes. Disabil Rehabil 2022; 44:6722-6729. [PMID: 34543157 DOI: 10.1080/09638288.2021.1971304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To report on serum 25-hydroxyvitamin D (25(OH)D) levels in post-acute hip fractured patients, revealed the associations between serum 25(OH)D levels and hip fractured patients' baseline characteristics and rehabilitation outcomes. MATERIALS AND METHODS A retrospective study (9/2017-9/2020) of 493 hip fractured patients. 25(OH)D levels were recorded following the patient's baseline characteristics and outcome measures, including the functional independence measure and motor functional independence measure effectiveness. The sample was divided into three groups: deficient (<30 nmol/l), insufficient (30-75 nmol/l) and sufficient (>75 nmol/l) 25(OH)D levels. ANOVA and chi-square test tests compared the groups. Multiple linear analysis assessed the associations between the 25(OH)D and discharge functional independence measure score. RESULTS 25(OH)D deficiency was found in 20.3% of the patients. The only baseline characteristic significantly associated with serum 25(OH)D levels was dementia. The group with deficient levels of 25(OH)D exhibited a significantly higher rate of low education, low admission albumin levels and a reduced handgrip strength compared to the insufficient/sufficient groups. All functional measure scores were significantly lower in the deficient (25(OH)D) group compared with the insufficient/sufficient patient groups. 25(OH)D levels were found to be significantly associated with the discharge functional independence measure score. CONCLUSIONS Routine screening for 25(OH)D levels is mandatory in post-acute hip fracture patients as it may affect rehabilitation outcomes.Implications for Rehabilitation25-hydroxyvitamin D 25(OH)D levels are associated with rehabilitation outcomes in post-acute hip fractured patients.A routine screening for 25(OH)D levels and standardized supplementation protocol during the acute and post-acute rehabilitation setting is recommended as it may improve the quality of care.
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Affiliation(s)
- Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gal Maydan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Ronen Ben Joseph
- Geriatric Rehabilitation, Meir Medical Center, Kfar Saba, Israel
| | - Ran Nissan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
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Krull C, Abramoff BA, Jerome M, Principe J, Cai Q, Tailor Y. Intervention for Increasing Vitamin D Supplementation in a Deficient Rehabilitation Population: Outcomes of a Quality Improvement Initiative. PM R 2019; 11:1093-1100. [DOI: 10.1002/pmrj.12092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Christine Krull
- Department of Rehabilitation MedicineEmory University Atlanta GA
| | | | - Mairin Jerome
- Department of Rehabilitation MedicineEmory University Atlanta GA
| | - Jessica Principe
- Department of Rehabilitation MedicineEmory University Atlanta GA
| | - Qingpo Cai
- Department of Biostatistics and BioinformaticsEmory University Atlanta GA
| | - Yogita Tailor
- Department of Rehabilitation MedicineEmory University Atlanta GA
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Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture †. J Clin Med 2018; 7:jcm7080193. [PMID: 30071650 PMCID: PMC6111530 DOI: 10.3390/jcm7080193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/28/2018] [Accepted: 07/28/2018] [Indexed: 12/14/2022] Open
Abstract
The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. OBJECTIVES (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2⁻13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6⁻39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.
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Di Monaco M, Castiglioni C, Di Carlo S, La Marmora E, Filipovic I, Milano E, Minetto MA, Massazza G. Classes of vitamin D status and functional outcome after hip fracture: a prospective, short-term study of 1350 inpatients. Eur J Phys Rehabil Med 2018; 55:56-62. [PMID: 29904045 DOI: 10.23736/s1973-9087.18.05191-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vitamin D depletion is associated with unfavourable outcomes after hip fracture. However, the classes of vitamin D status currently in use, which are defined according to serum calcifediol levels, have not been validated for their predictive capability of the functional recovery. AIM To investigate the association between serum calcifediol categorized into 4 classes and the functional recovery after hip fracture. DESIGN Prospective, short-term observational study. SETTING Rehabilitation hospital in Italy. POPULATION We evaluated 1350 of 1412 inpatients with hip fracture. METHODS Serum calcifediol was measured by an immunoenzymatic assay 14.7±4.4 (mean±SD) days after surgery and categorized into 4 classes: I class <12 ng/mL; II class 12-20 ng/mL; III class 21-29 ng/mL; IV class ≥30ng/mL. The functional outcome was assessed by using the Barthel Index. RESULTS We found a significant difference in Barthel index scores at the end of inpatient rehabilitation across the 4 classes of vitamin D status: χ2 (3, N.=1350) 27.2; P<0.001. The difference persisted after adjustment for 8 covariates (P=0.004). By comparing pairs of classes, we found that Barthel index scores were lower in the 829 patients of the I class than in the 275 of the II (P=0.005) who had in turn Barthel index scores lower than the 132 patients of the III class (P=0.038). Conversely, no significant differences emerged between the patients of the III class and the 114 patients of the IV class (P=0.421). The results did not materially change when Barthel Index effectiveness was substituted for Barthel Index scores as the outcome measure. CONCLUSIONS Calcifediol levels below 12ng/mL were associated with a worse recovery than those between 12 and 20ng/mL that were in turn associated with a worse recovery than those between 21 and 29 ng/mL. Conversely, no significant differences were found between the patients with calcifediol between 21 and 29ng/mL and those with calcifediol ≥30 ng/mL. CLINICAL REHABILITATION IMPACT Despite caution due to the observational design, our study suggests that vitamin D depletion should be treated after hip fracture to optimize the functional outcome, with a target level for serum calcifediol of 21-29ng/mL and no further advantages associated with calcifediol levels of 30ng/mL or higher.
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Affiliation(s)
- Marco Di Monaco
- Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy -
| | - Carlotta Castiglioni
- Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy
| | - Silvia Di Carlo
- Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy
| | - Elena La Marmora
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Irena Filipovic
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo Milano
- Division of Physical Medicine and Rehabilitation, Osteoporosis Research Center, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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Sari A, Durmus B, Karaman CA, Ogut E, Aktas I. A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients. J Phys Ther Sci 2018; 30:874-878. [PMID: 29950783 PMCID: PMC6016314 DOI: 10.1589/jpts.30.874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/27/2018] [Indexed: 01/23/2023] Open
Abstract
[Purpose] To investigate the effect of vitamin D supplementation on rehabilitation outcomes and balance in patients having hemiplegia due to ischemic stroke. [Subjects and Methods] Vitamin D levels of 132 patients hospitalized for hemiplegia rehabilitation due to ischemic stroke were tested. Consequently, 86/132 patients had low vitamin D levels, 72 of which met the inclusion criteria and were included in the study. Patients were divided into two groups: Group A (injected with 300,000 IU vitamin D), and Group B (injected intramuscularly with saline). Each patient was tested at the baseline and at the third month using the Brunnstrom recovery staging, functional ambulation scale, modified Barthel index, and Berg balance scale. The findings were compared between the groups. [Results] By the end of the third month, The Berg balance scale results and modified Barthel index scores significantly differed between the two groups, whereas Brunnstrom recovery staging and functional ambulation scale test results did not. [Conclusion] This study found that vitamin D administration increased the activity levels and accelerated balance recovery but did not significantly affect ambulation or motor recovery. These results warrant confirmation by longer follow-up studies with a larger number of participants.
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Affiliation(s)
- Aylin Sari
- Department of Physical Therapy and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital: Semsettin Gunaltay Avenue Sultan Street No:14, Kadikoy 34736 Istanbul, Turkey
| | - Bekir Durmus
- Department of Physical Therapy and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital: Semsettin Gunaltay Avenue Sultan Street No:14, Kadikoy 34736 Istanbul, Turkey
| | - Cigdem Arifoglu Karaman
- Department of Physical Therapy and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital: Semsettin Gunaltay Avenue Sultan Street No:14, Kadikoy 34736 Istanbul, Turkey
| | - Evrim Ogut
- Department of Physical Therapy and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital: Semsettin Gunaltay Avenue Sultan Street No:14, Kadikoy 34736 Istanbul, Turkey
| | - Ilknur Aktas
- Department of Physical medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Turkey
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Invernizzi M, Noale M, Iolascon G, Letizia Mauro G, Falaschi P, Arioli G, Maggi S, Cisari C. Vertebral fractures, function and cognitive status in osteoporotic hip fractured women: The FOCUS study. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grbovic V, Skevin AJ, Ilic KP, Tomic AL, Nurkovic J, Jeremic D, Djordjevic D. Correlations Between Clinical Parameters and Health-Related Quality of Life in Postmenopausal Osteoporotic Women. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The purpose of this study was to assess the correlation between health-related quality of life (HRQoL) and clinically relevant osteodensitometric and biochemical parameters in postmenopausal osteoporotic women. Bone mineral density (BMD) and T scores of the lumbar vertebrae and femoral neck were assessed in 100 osteoporotic women (56 without previous fractures and 44 with previous fractures) using dual x-ray absorptiometry. The Fracture Risk Assessment Tool (FRAX) index for major osteoporotic and hip fractures was calculated based on demographic data and hip BMD. Venous blood samples were taken from each subject for biochemical analysis (serum calcium, phosphorus, alkaline phosphatase and vitamin D levels). HRQoL was assessed using the QUALEFFO-41 questionnaire (domains: Health perception, Pain, and Physical, Social and Mental function). Basic participant characteristics (age, menopause length, body mass index, smoking habits, hereditary tendency towards fracture, fracture history) correlated with some of the QUALEFFO-41 domains, but the correlation coefficients were low (r<0.3), except in the case of the correlation between Pain and fracture history (r=0.638). Of the six variables included in the multiple regression model, fracture history was shown to be the most significant predictor with respect to the following three QUALEFFO-41 domains: Pain (b=20.511), Social function (b=2.548) and Health perception (b=3.185). Correlation analysis showed that after adjustment for basic characteristics, BMD and T score of the femoral neck and Pain (r=0.331 and r=0.449, respectively), Social function (r=0.422 and r=0.419) and Health perception (r=0.434 for T score of the femoral neck) exhibited the strongest correlations. Vitamin D was negatively correlated with Mental function, while the other biochemical parameters exhibited variable correlations with the QUALEFFO- 41 domains (r≈0.2-0.5). Our study confirmed the previously established relationship between BMD of the femoral neck and HRQoL in patients with osteoporosis and demonstrated correlations between various blood bone metabolism parameters and HRQoL that have not been previously investigated.
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Affiliation(s)
- Vesna Grbovic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandra Jurisic Skevin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Katarina Parezanovic Ilic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandra Lucic Tomic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Jasmin Nurkovic
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia
| | - Dejan Jeremic
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Dusica Djordjevic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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Lv JT, Zhang YY, Tian SQ, Sun K. Serum of 25-Hydroxyvitamin D and Intact Parathyroid Hormone Levels in Postmenopausal Women with Hip and Upper Limb Fractures. J Am Geriatr Soc 2016; 64:1068-72. [PMID: 27131061 DOI: 10.1111/jgs.14082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the serum of 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH) levels in postmenopausal women from northern China with hip and upper limb fractures. DESIGN Case-control. SETTING Affiliated Hospital of Qingdao University. PARTICIPANTS Postmenopausal women diagnosed with hip fracture (n = 335) and matched controls without fracture (n = 335). MEASUREMENTS Between 2011 and 2013, fasting venous samples were analyzed for 25(OH)D, iPTH, alkaline phosphatase (ALP), calcium, and phosphorus. All women completed a standardized questionnaire designed to document putative risk factors for fractures. RESULTS Eight percent of participants had vitamin D deficiency, and 66.0% had secondary hyperparathyroidism. Serum 25(OH)D levels were significantly (P < .001) lower in women with hip fracture than in controls. Multivariate logistic regression analysis adjusted for common risk factors showed that serum 25(OH)D of 20 ng/mL or less was an independent indicator of hip fracture (odds ratio (OR) = 2.98, 95% confidence interval (CI) = 2.11-4.20) and concomitant upper limb fracture in those with existing hip fractures (OR = 4.77, 95% CI = 1.60-10.12). The area under the receiver operating characteristic curve of 25(OH)D was 0.77 (95% CI = 0.68-0.84) for hip fracture and 0.80 (95% CI = 0.72-0.89) for hip and upper limb fractures. CONCLUSION Vitamin D insufficiency and secondary hyperparathyroidism were a common problem in postmenopausal women who presented with concomitant hip and upper limb fractures, suggesting that they might contribute to the pathophysiology of fractures in postmenopausal women.
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Affiliation(s)
- Jiang-Tao Lv
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong Province, China
| | - Ying-Ying Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong Province, China
| | - Shao-Qi Tian
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong Province, China
| | - Kang Sun
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong Province, China
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Alarcón T, González-Montalvo JI, Martín-Vega A, Gotor P. Improving persistence and adherence to osteoporosis treatment: a challenge to solve. Osteoporos Int 2016; 27:1275-1276. [PMID: 26391035 DOI: 10.1007/s00198-015-3323-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 12/31/2022]
Affiliation(s)
- T Alarcón
- Acute Orthogeriatric Unit, Geriatrics Department, La Paz University Hospital, Madrid, Spain.
- Medical School, Autonoma University, Madrid, Spain.
- IdiPAZ, La Paz University Hospital, Madrid, Spain.
- Servicio de Geriatría, Hospital Universitario La Paz, Paseo Castellana 261, 28046, Madrid, Spain.
| | - J I González-Montalvo
- Acute Orthogeriatric Unit, Geriatrics Department, La Paz University Hospital, Madrid, Spain
- Medical School, Autonoma University, Madrid, Spain
- IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - A Martín-Vega
- Department of Clinical Management, La Paz University Hospital, Madrid, Spain
| | - P Gotor
- Acute Orthogeriatric Unit, Geriatrics Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ, La Paz University Hospital, Madrid, Spain
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Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation. Arch Orthop Trauma Surg 2016; 136:339-44. [PMID: 26660079 DOI: 10.1007/s00402-015-2376-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Hypovitaminosis D is common in patients undergoing orthopaedic trauma surgery. While previous studies have shown that vitamin D levels correlate with functional outcome after hip fracture surgery, the significance of vitamin D levels on outcomes after surgery in other orthopaedic trauma patients is unknown. The purpose of this study was to determine if vitamin D levels correlated with outcomes in ankle fracture patients. MATERIALS AND METHODS We reviewed a prospective registry of patients who underwent operative treatment for ankle fractures from 2003 to 2012. Preoperative serum 25-hydroxyvitamin D (25[OH]D) levels were measured, and the primary and secondary outcomes included foot and ankle outcome scores (FAOS) and ankle range of motion. Data were also collected on patient comorbidities, articular malreductions, and wound complications. Included patients had at least 12 months of clinical outcome data. RESULTS Ninety-eight patients operatively treated for ankle fractures met our inclusion criteria. Of these 98 patients, 36 (37%) were deficient in vitamin D (<20 ng/ml) and 31 (32%) had vitamin D insufficiency (<30 ng/ml, ≥20 mg/ml). Patients with vitamin D deficiency were similar with regard to age, gender, and comorbidities compared to patients with vitamin D levels ≥20. Univariate analysis revealed that patients with vitamin D deficiency had significantly worse FAOS with regard to symptoms (P = 0.017) and quality of life (P = 0.040) domains than patients with vitamin D levels ≥20. Multivariate regression analysis suggested that vitamin D deficiency was a factor in inferior FAOS with regard to symptoms, activities of daily living, and quality of life. CONCLUSIONS In our group of patients with operative treated ankle fractures, preoperative vitamin D deficiency correlated with inferior clinical outcomes at a minimum of 1 year follow-up. Our study suggests that deficient vitamin D levels may result in worse outcomes in orthopaedic trauma patients recovering from fracture fixation.
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Prevalence of Vitamin D Deficiency in Elderly Patients Admitted to an Inpatient Rehabilitation Unit in Tropical Singapore. Rehabil Res Pract 2016; 2016:9689760. [PMID: 26998361 PMCID: PMC4779827 DOI: 10.1155/2016/9689760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/26/2016] [Indexed: 12/05/2022] Open
Abstract
Background. Data on hypovitaminosis D in elderly patients admitted to rehabilitation units in tropical countries are scarce. Objective. To assess the prevalence of vitamin D deficiency and its associated risk factors in elderly patients admitted to a rehabilitation unit in tropical Singapore. Methods. Prospective, cohort study of 134 subjects ≥ 65 years old admitted to a tertiary rehabilitation centre. Serum 25-hydroxyvitamin D3 (25OHD3) was measured on rehabilitation admission. Results. Mean age was 72.0 ± 5.7 years, and stroke was the commonest rehabilitation diagnosis (49.3%). Low 25OHD3 levels were present in 115 patients (85.6%) and 59 patients (44%) were deemed to be vitamin D deficient. The mean PTH level was significantly higher in patients with low 25OHD3 levels. (p = 0.002) Age, gender, vitamin D supplementation, premorbid ambulatory status, and admission/discharge Functional Independence Measure scores were not significantly associated with vitamin D deficiency. Malays/Indians (p = 0.013) and recurrent fallers (p = 0.029) were at significantly higher risk of vitamin D deficiency. Conclusions. Despite the tropical weather, vitamin D deficiency is common in elderly subjects admitted to a rehabilitation unit in Singapore. Routine assessment of vitamin D levels is recommended especially in those with a history of recurrent falls and patients of Indian/Malay ethnicity.
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Low 25(OH) D serum levels are related with hip fracture in postmenopausal women: a matched case-control study. J Transl Med 2015; 13:388. [PMID: 26699707 PMCID: PMC4690420 DOI: 10.1186/s12967-015-0756-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 12/16/2015] [Indexed: 02/03/2023] Open
Abstract
Purpose There is limited information on the prevalence of vitamin D deficiency among patients diagnosed with hip fracture in the Chinese Han population. Therefore, the aim of this study was to assess the effects of change in the serum levels of 25-hydroxyvitamin D [25(OH) D] and intact parathyroid hormone (iPTH) among postmenopausal women in North China with confirmed hip fracture. Methods This study was done from May 1, 2012 to April 30, 2014. Three hundred and forty-nine postmenopausal women who were diagnosed with first-ever hip fracture and 349 matched controls without fracture were used for this study. The 25(OH) D, iPTH, alkaline phosphatase, calcium, and phosphorus levels were measured in fasting venous blood samples collected from the subjects. A predesigned questionnaire was used to collect information on covariates for multivariate analyses to evaluate the hypothesized relationship between vitamin D deficiency and fracture risk. Results The serum 25(OH) D levels were found to be significantly (P < 0.0001) lower in hip fracture patients than in the controls [37.0 (interquartile range [IQR] 28.0–48.0) nmol/L vs. 41.3 (IQR 32.0–54.5) nmol/L; P < 0.0001], and the iPTH levels were significantly higher in the former group [10.2 (IQR 6.3–14.9) pmol/L vs. 5.8 (IQR 4.1–6.6) pmol/L; P < 0.0001]. Further, a 25(OH) D level ≤50 nmol/L was found to independently indicate the occurrence of hip fracture [odds ratio (OR), 3.023; 95 % confidence interval (CI) 2.154–4.298], as well as hip fracture with concomitant upper limb fracture (OR 4.473; 95 % CI 2.984–10.532). Similarly, a serum iPTH level ≥6.8 pmol/L independently indicated the development of hip fracture (OR 2.498; 95 % CI 1.764–3.942), as well as hip fracture with concomitant upper limb fracture (OR 3.254; 95 % CI 1.998–7.984). Conclusions Vitamin D insufficiency and secondary hyperparathyroidism were found to be common problems in the sample of postmenopausal women who had experienced hip fracture. Monitoring the alterations in the serum levels of 25(OH) D and iPTH could be applied clinically as independent risk factors for hip fracture.
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Serum Levels of 25-hydroxyvitamin D and Functional Outcome in Older Patients with Hip Fracture. J Arthroplasty 2015; 30:891-4. [PMID: 25603761 DOI: 10.1016/j.arth.2014.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 02/01/2023] Open
Abstract
The aim was to assess prognostic value of serum 25-hydroxyvitamin D (25[OH] D) levels in older Chinese patients with hip fracture. From June, 2012 to February, 2014, older patients with hip fracture were included. Serum 25(OH) D levels were measured at admission. The functional evaluation at the time of discharge was performed by the Barthel Index. In the 66 patients with an unfavorable outcome, serum 25(OH) D levels were lower compared with those with a favorable outcome. In multivariate analyses, there was an increased risk of unfavorable outcome associated with serum 25(OH) D levels ≤ 20 ng/ml (OR 5.25, 95% CI: 3.12-8.16). Our data supported an association between serum 25[OH] D levels at admission and short-term prognosis in Chinese older patients with hip fracture.
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Serum levels of 25-hydroxyvitamin D and functional outcome among postmenopausal women with hip fracture. PLoS One 2015; 10:e0116375. [PMID: 25635882 PMCID: PMC4312033 DOI: 10.1371/journal.pone.0116375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023] Open
Abstract
Objective The main objective of the current study was to assess the distribution and
its prognostic value of serum 25-hydroxyvitamin D (25[OH] D) levels assessed
at admission in Chinese postmenopausal women with hip fracture. Methods From January 1, 2012 to December 31, 2013, all postmenopausal women with
first-ever hip fracture were recruited to participate in the study. Serum
25[OH] D levels were measured at admission. The functional evaluation at the
time of discharge was performed by the Barthel Index (BI). The prognostic
value of 25[OH] D to predict the functional outcome within discharge was
analyzed by logistic regression analysis, after adjusting for the possible
confounders. Results In our study, 261 patients were included and assessed. In the 76 patients
with an unfavorable functional outcome, serum 25(OH) D levels were lower
compared with those in patients with a favorable outcome [11.8(IQR,
9.9–16.1)ng/ml; 16.8(IQR, 13.6–21.4)ng/ml, respectively; P<0.0001]. In
multivariate analysis, there was an increased risk of unfavorable outcome
associated with serum 25(OH) D levels ≤ 20ng/ml (OR 5.24, 95%CI: 3.11–8.15;
P<0.0001) after adjusting for possible confounders. Conclusions Our data support an association between serum 25[OH] D levels and prognosis
in Chinese postmenopausal women with hip fracture.
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Parchi P, Andreani L, Piolanti N, Niccolai F, Cervi V, Lisanti M. Effect of vitamin D in fracture healing in a child: case report. Arch Osteoporos 2014; 9:170. [PMID: 24452512 DOI: 10.1007/s11657-013-0170-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/13/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this report, we describe the effect of vitamin D and calcium supplementation on fracture healing in a young boy with a hypovitaminosis D who had a radius refracture. The radiographic evaluation of the callus formation shows a clear effect of vitamin D on fracture healing in absence of additional variables. INTRODUCTION Fracture healing restores the tissue to its original physical and mechanical properties and it involves a complex multistep process that involves response to injury, intramembranous bone formation, chondrogenesis, endochondral bone formation, and bone remodeling. All this process is influenced by a variety of systemic and local factors. It is generally assumed that vitamin D plays an intimate role in healing fractures; however, very little data exists on how it does. CASE REPORT In this report, the authors describe the effect of vitamin D and calcium supplementation on fracture healing in a young boy with a hypovitaminosis D who had a radius refracture. CONCLUSIONS Our case report suggests that the hypovitaminosis D is a possible cause of inadequate fracture healing and refracture in children and it shows a clear effect of vitamin D supplementation on callus formation in the absence of additional variables.
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Affiliation(s)
- Paolo Parchi
- 1st Orthopedic Division, Department of Traslational Research and New Technology in Medicine and Surgery, University of Pisa, via Paradisa 2, 56125, Pisa, Italy,
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Kojima G, Tamai A, Masaki K, Gatchell G, Epure J, China C, Ross GW, Petrovitch H, Tanabe M. Prevalence of vitamin D deficiency and association with functional status in newly admitted male veteran nursing home residents. J Am Geriatr Soc 2013; 61:1953-7. [PMID: 24117324 DOI: 10.1111/jgs.12495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide the first report on prevalence of vitamin D deficiency in newly admitted nursing home (NH) residents and associations with functional disabilities and chronic diseases. DESIGN Retrospective chart review. SETTING Nursing home (NH). PARTICIPANTS Male veterans newly admitted to a NH for rehabilitation, skilled-nursing care, intermediate care, or respite care between January 2011 and June 2012. MEASUREMENTS Total serum 25-hydroxyvitamin D (25(OH)D) levels were measured on admission. Vitamin D supplement users and those without 25(OH)D measurement within 7 days of admission were excluded, leaving an analytical sample of 104 residents. Vitamin D deficiency was defined as 25(OH)D less than 20 ng/mL. Data were collected on age, ethnicity, season, body mass index (BMI), functional disability in activities of daily living (ADLs) (mobility, bathing, dressing, toileting, continence, and feeding), and prevalent chronic diseases. RESULTS Prevalence of vitamin D deficiency was 49.0%. In multivariate logistic regression models adjusted for age, ethnicity, and BMI, vitamin D deficiency was significantly associated with number of ADL disabilities (odds ratio (OR) = 1.4 for each 1-point increase in ADL disability score, P = .03) and prevalent diabetes mellitus (OR = 3.0, P = .03). In regression models using each ADL disability as a separate variable, only disability in feeding (OR = 4.7, P = .05) and diabetes mellitus (OR = 2.9, P = .04) remained significant. CONCLUSION Almost half the individuals entering the NH and not taking vitamin D supplements had vitamin D deficiency. Greater number of ADL disabilities, disability in feeding, and prevalent diabetes mellitus were independently associated with vitamin D deficiency.
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Affiliation(s)
- Gotaro Kojima
- Community Living Center, Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; Department of Geriatric Medicine, John A. Hartford Foundation Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Unnanuntana A, Rebolledo BJ, Gladnick BP, Nguyen JT, Sculco TP, Cornell CN, Lane JM. Does vitamin D status affect the attainment of in-hospital functional milestones after total hip arthroplasty? J Arthroplasty 2012; 27:482-9. [PMID: 21752584 DOI: 10.1016/j.arth.2011.05.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 05/17/2011] [Indexed: 02/01/2023] Open
Abstract
Our study aims to identify the prevalence of low vitamin D status in patients undergoing total hip arthroplasty (THA) and to evaluate the association between serum vitamin D level and the attainment of in-hospital functional milestones. We collected data from patients who underwent THA and had preoperative serum vitamin D (serum 25-hydroxy vitamin D) levels measured. From 200 patients, 79 (39.5%) had low serum vitamin D (serum 25-hydroxy vitamin D <32 ng/mL). There were no associations between serum vitamin D level and the attainment of in-hospital functional milestones as well as length of hospital stay or perioperative complications after THA. Because low vitamin D status did not compromise the short-term functional outcomes after THA, surgery need not be delayed, but low vitamin D levels should be corrected once identified.
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Affiliation(s)
- Aasis Unnanuntana
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R. Appendicular Lean Mass Does Not Mediate the Significant Association Between Vitamin D Status and Functional Outcome in Hip-Fracture Women. Arch Phys Med Rehabil 2011; 92:271-6. [DOI: 10.1016/j.apmr.2010.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/30/2010] [Accepted: 09/24/2010] [Indexed: 12/18/2022]
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The Burden of Prevalent Vertebral Fractures is Negatively Associated with Functional Outcome in Women with Hip Fracture. Am J Phys Med Rehabil 2011; 90:1-7. [DOI: 10.1097/phm.0b013e31820174e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Di Monaco M, Trucco M, Di Monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil 2010; 24:543-54. [DOI: 10.1177/0269215509353265] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare the predictive validity of trunk control in sitting position assessed by Trunk Impairment Scale and balance in lying, sitting and standing posture assessed by Postural Assessment Scale for Stroke patients on functional outcome in stroke survivors. Design: Prospective observational study. Setting: A single rehabilitation hospital in Italy. Subjects: Sixty of 68 consecutive subjects admitted to a rehabilitation hospital after stroke. Main measures: We performed Trunk Impairment Scale and Postural Assessment Scale for Stroke patients at admission to inpatient rehabilitation. Outcome measures at discharge were Functional Independence Measure score and destination (classified as either home or institution). Results: After adjustment for 14 potential confounders, including Functional Independence Measure score at admission to rehabilitation, both Trunk Impairment Scale and Postural Assessment Scale for Stroke patients scores were significantly associated with the Functional Independence Measure score at discharge (P = 0.010 and P =0.04, respectively), change in the Functional Independence Measure score during rehabilitation (P = 0.003 and P<0.001, respectively), Functional Independence Measure effectiveness (P = 0.024 and P =0.017, respectively) and destination at discharge (P = 0.040 and P =0.032, respectively). The panel of prognostic variables predicted 64—65% of the variance in the final Functional Independence Measure score, 30—35% of the variance in the change of the Functional Independence Measure score during rehabilitation, and 45—46% of the variance in the Functional Independence Measure effectiveness depending on the inclusion of either Trunk Impairment Scale or Postural Assessment Scale for Stroke patients score among the predictors.
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Affiliation(s)
- Marco Di Monaco
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo,
| | - Marco Trucco
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo
| | | | - Rosa Tappero
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Turin, Italy
| | - Alberto Cavanna
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Turin, Italy
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Di Monaco M, Vallero F, Tappero R, De Lauso L, De Toma E, Cavanna A. Incident falls impair ability to function in hip-fracture survivors: A prospective study of 95 elderly women. Arch Gerontol Geriatr 2009; 48:397-400. [DOI: 10.1016/j.archger.2008.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 03/15/2008] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
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Type of Hip Fracture in Patients With Parkinson Disease is Associated With Femoral Bone Mineral Density. Arch Phys Med Rehabil 2008; 89:2297-301. [DOI: 10.1016/j.apmr.2008.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 05/09/2008] [Accepted: 06/01/2008] [Indexed: 11/23/2022]
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Basaran S, Guzel R, Coskun-Benlidayi I, Guler-Uysal F. Vitamin D status: effects on quality of life in osteoporosis among Turkish women. Qual Life Res 2007; 16:1491-9. [PMID: 17828579 DOI: 10.1007/s11136-007-9257-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 08/13/2007] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Vitamin D deficiency causes muscle weakness, impairs bone formation and neuromuscular coordination thus leading to an increase in fracture risk. It has been found that inadequate levels of vitamin D are present in most of the osteoporosis patients. However, very few studies investigate the association between vitamin D status and quality of life (QOL). The aim of this study is to investigate the effects of vitamin D on QOL among Turkish women with osteoporosis. METHODS 259 patients (61.0 +/- 8.9 years) with osteoporosis were evaluated by physical activity level, back pain, bone turnover markers, 25-hydroxyvitamin D [25(OH)D], parathyroid hormone levels and bone mineral density. QOL was assessed using QOL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). 25(OH)D levels below 20 ng/ml was defined as vitamin D insufficiency, below 12 ng/ml as vitamin D deficiency. RESULTS Mean 25(OH)D level was 22.7 +/- 12.6 ng/ml and mean total QUALEFFO score was 43.3 +/- 14.9. Vitamin D levels were significantly correlated with all subscales and total score of QUALEFFO (r = -0.25, P = 0.0001). Vitamin D insufficiency was determined in 132 patients (51%). In vitamin D deficient (<12 ng/ml) group all subscales and total QOL were found to be poorer when compared with the groups whose vitamin D levels were > or = 12 and <20 ng/ml and > or = 20 ng/ml (effect sizes 0.41 and 0.62 respectively, P = 0.0001 for total QOL). Vitamin D level, education, concomitant diseases, physical activity level and pain severity were found to be significantly associated with QOL in multiple linear regression analysis model. CONCLUSIONS Vitamin D insufficiency affects physical, social and mental functions of osteoporosis patients and impairs QOL. Vitamin D was found to be one of the factors affecting QOL.
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Affiliation(s)
- Sibel Basaran
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana 01330, Turkey.
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Kiebzak GM, Moore NL, Margolis S, Hollis B, Kevorkian CG. Vitamin D Status of Patients Admitted to a Hospital Rehabilitation Unit. Am J Phys Med Rehabil 2007; 86:435-45. [PMID: 17515682 DOI: 10.1097/phm.0b013e31805b7e20] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The primary objective was to determine the association between vitamin D status, baseline function, and short-term inpatient rehabilitation progress. DESIGN This was a prospective convenience sampling of 100 patients in a tertiary general hospital rehabilitation unit (RU). The cohort comprised men and women of mixed race with a variety of diagnoses (mean age 70 yrs). Patient histories and demographic information were obtained by patient interview and chart review. Serum 25-hydroxyvitamin D (25OHD) (nmol/L) was measured on or after the day of admission. The Functional Independence Measurement (FIM) instrument, a validated survey tool, was used to measure function at admission and discharge. RESULTS Eleven percent of the patients were overtly vitamin D deficient, with serum 25OHD concentrations <20 nmol/L. Ninety-four percent of the patients had serum 25OHD concentrations below the recommended minimum optimal concentration of 80 nmol/L. Using the Spearman rank correlation test, low serum 25OHD was weakly but significantly associated with low total FIM scores: r = 0.25 (P < 0.012) and r = 0.23 (P < 0.021) for admission and discharge total FIM score, respectively. Patients with serum 25OHD concentrations greater than the median value of 41.3 nmol/L had significantly higher FIM efficiency scores (discharge total FIM score - admission total FIM score/length of stay [LOS]) than the subgroup of patients below the median (2.0 +/- 1.1 vs. 1.6 +/- 0.9, respectively; P < or = 0.026). Serum 25OHD was not significantly correlated with FIM efficiency or the unadjusted change in total FIM score (discharge total FIM score - admission total FIM score), but it was significantly correlated with LOS (the lower the serum 25OHD concentration, the longer the LOS, and vice versa; r = -0.235, P < 0.018). Thus, the difference in FIM efficiency between patients with serum 25OHD above and below the median was the result of the significant inverse correlation between serum 25OHD and LOS; as a group, patients with serum 25OHD above the median had a 19% shorter LOS than the group with serum 25OHD below the median value (11.4 +/- 4.9 vs. 14.1 +/- 5.6 days, respectively; P = 0.005). CONCLUSIONS Most patients in a hospital RU had a suboptimal serum 25OHD concentration, reflecting what has previously been observed in hospitalized patients in general and also the population at large. Although no specific physical deficits or attributes could be directly attributed to low serum 25OHD, the baseline functional status of RU patients, LOS, and progress attributable to inpatient rehabilitation (FIM efficiency) were favorably affected by higher serum 25OHD concentrations.
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Affiliation(s)
- Gary M Kiebzak
- Center for Orthopaedic Research and Education, St. Luke's Belmont Center, St. Luke's Episcopal Hospital, Houston, TX 77025, USA
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Sakuma M, Endo N, Oinuma T. Serum 25-OHD insufficiency as a risk factor for hip fracture. J Bone Miner Metab 2007; 25:147-50. [PMID: 17447111 DOI: 10.1007/s00774-007-0749-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
The aging population and an increasing number of hip fractures worldwide have made prevention of hip fractures a matter of importance. The prevalence of hypovitaminosis D in patients with acute hip fracture has been reported widely in recent years, and the vitamin D nutritional status in such reports is usually evaluated based on serum 25-hydroxyvitamin D (25-OHD). The aim of this article is to review the relationship of serum 25-OHD and osteoporotic fracture and the prevalence of 25-OHD insufficiency in patients with hip fracture, including assessment of nutritional status, oral status, activity, and dementia. We conclude that the serum 25-OHD level may be a useful index for risk of hip fracture in elderly people.
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Affiliation(s)
- Mayumi Sakuma
- Division of Rehabilitation Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi dori, Niigata 951-8510, Japan.
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Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. Bone Mineral Density in Hip-Fracture Patients With Parkinson’s Disease: A Case-Control Study. Arch Phys Med Rehabil 2006; 87:1459-62. [PMID: 17084120 DOI: 10.1016/j.apmr.2006.07.265] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate bone mineral density (BMD) levels in patients with Parkinson's disease (PD) who sustained a hip fracture. DESIGN Case-control study. SETTING Rehabilitation hospital in Italy. PARTICIPANTS We investigated 831 out of 887 white patients consecutively admitted to a rehabilitation hospital because of an original hip fracture resulting from a fall. Twenty-eight (3.37%) of the 831 patients were affected by PD. Twenty-eight controls matched for sex, age, and hip-fracture type (cervical or trochanteric) were found among the 803 non-PD patients. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BMD was assessed by dual-energy x-ray absorptiometry (DXA) at the unfractured femur. Five sites were investigated in each subject: total proximal femur, femoral neck, trochanter, intertrochanteric area, and Ward's triangle. DXA scan was performed a mean +/- standard deviation of 22.2 +/- 7.8 days after fracture occurrence in the 28 patients and 22.0 +/- 5.3 days after fracture occurrence in the 28 controls. RESULTS BMD expressed as a T score did not differ significantly between the 28 PD patients and the 28 controls, whereas z score in the PD patients was significantly lower than 0 +/- 1 in the age- and sex-matched general population at 4 of the 5 sites of BMD assessment. CONCLUSIONS A sample of PD fallers who sustained a hip fracture had femoral BMD levels similar to those found in matched hip-fracture fallers who did not suffer from PD and significantly lower than those found in the matched reference population.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center, Presidio Sanitario San Camillo, Torino, Italy.
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Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. 25-hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients. J Bone Miner Metab 2006; 24:42-7. [PMID: 16369897 DOI: 10.1007/s00774-005-0644-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 08/15/2005] [Indexed: 11/30/2022]
Abstract
There is increasing interest in the effects of vitamin D and parathyroid hormone (PTH) on extraskeletal tissues, including the muscle. These effects may explain impairment in functional ability found in vitamin D-deficient subjects. Our aim was to investigate the roles of vitamin D and PTH in affecting the ability to perform activities of daily living after hip fracture. We studied 456 of 521 hip-fracture patients admitted consecutively to a rehabilitation hospital. Functional outcome was assessed after acute inpatient rehabilitation by using the Barthel index score. The functional scores were significantly correlated with serum levels of 25-hydroxyvitamin D (rho = 0.190; P < 0.001) and PTH (rho = -0.164; P < 0.001) and the 25-hydroxyvitamin D/PTH ratio (rho = 0.261; P < 0.001). At multiple regression, 25-hydroxyvitamin D and PTH levels were independently associated with Barthel index scores. The correlation between the 25-hydroxyvitamin D/PTH ratio and Barthel index scores was significantly stronger than the one between 25-hydroxyvitamin D and Barthel index scores (difference between the two correlation coefficients = 0.071; 95% CI = 0.009-0.133; P = 0.011). The significant association between the 25-hydroxyvitamin D/PTH ratio and the Barthel index scores persisted after adjustment for 12 prognostic factors (P = 0.012). On the whole, the panel of prognostic factors we studied predicted 50.1% of the variance of the functional score. Data shows that PTH and 25-hydroxyvitamin D were significantly associated with the ability to function after hip fracture and suggest that the two hormones act through independent mechanisms. The 25-hydroxyvitamin D/PTH ratio significantly contributed to a predictive model of functional outcome.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center, Presidio Sanitario San Camillo, Strada Santa Margherita 136, 10131 Torino, Italy.
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Sakuma M, Endo N, Oinuma T, Hayami T, Endo E, Yazawa T, Watanabe K, Watanabe S. Vitamin D and intact PTH status in patients with hip fracture. Osteoporos Int 2006; 17:1608-14. [PMID: 16874442 DOI: 10.1007/s00198-006-0167-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 05/03/2006] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The prevalence of hypovitaminosis D in patients with acute hip fracture was examined in a population on Sado Island in Japan. There were 85 cases of hip fracture among this population in 2004, giving an overall incidence of hip fracture of 121.4 per 100,000 population per year. This study included 50 of the 85 cases, and these cases were defined as the hip fracture group. Patients older than 70 years without established osteoporosis who were admitted to the hospital on the island during almost the same period for treatment of an orthopedic condition other than a hip fracture were defined as the control group. MATERIALS AND METHODS The levels of serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (intact PTH), alkaline phosphatase (ALP), albumin, and the number of remaining teeth were examined in each group. In the hip fracture group, serum calcium, serum phosphorus, urine N-terminal cross-linking telopeptide of type I collagen (NTx), bone mineral density (BMD) of the nonfractured hip, the presence of a vertebral fracture on X-ray, severity of dementia, and physical activity level were also examined. RESULTS Both the serum 25-OHD and serum albumin levels were significantly lower in patients with hip fracture than in controls, and the intact PTH level was significantly higher in patients with hip fracture. The number of remaining teeth was correlated with age, and was also significantly correlated with 25-OHD. In the hip fracture group, 62% of the subjects had hypovitaminosis D (25-OHD <20 ng/ml) and one-fifth of cases with hypovitaminosis D showed elevated PTH levels (>65 pg/ml). On the other hand, in the control group, hypovitaminosis D occurred in 18.9% of the subjects, and only one case showed elevated PTH. The serum 25-OHD level showed a decrease as the severity of dementia progressed and the activity level decreased. CONCLUSION Our results indicate that about two-thirds (62%) of hip fracture patients had vitamin D insufficiency, suggesting that this condition may be closely associated with hip fracture in elderly people. Therefore, the serum 25-OHD level may be a useful index for the risk of hip fracture in elderly people.
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Affiliation(s)
- M Sakuma
- Division of Rehabilitation Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi dori, Niigata, 951-8510, Japan.
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