Déficit de vitamina D en el adulto: clínica, diagnóstico y tratamiento

[Prevalence of osteoporosis, estimation of probability of fracture and bone metabolism study in patients with newly diagnosed prostate cancer in the health area of Lugo]

OBJECTIVE

To study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer.

DESIGN

Observational descriptive transversal study. SITE: Study performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital.

PARTICIPANTS

Patients diagnosed with prostate cancer without bone metastatic disease from January to December 2012.

MAIN MEASUREMENTS

Epidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX^® Tool.

RESULTS

Eighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia. The average fracture risk in this population, estimated by FRAX^®, was 2.63% for hip fracture and 5.28% for major fracture. Cut level for FRAX^® major fracture value without DXA >5% and ≥7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively.

CONCLUSIONS

The prevalence of osteoporosis in this population was very high. The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture. The probability of fracture using femoral neck FRAX^® tool was low. Vitamin D deficiency was very common (98.8%).

[Vitamin D deficiency in morbidly obese patients. A case-control study]

OBJECTIVES

Recent studies show a high prevalence of vitamin D deficiency in the general population, especially in the elderly. There are also studies reporting the same observations in the morbidly obese, although few of these studies have compared morbidly obese individuals with non-obese persons. The objectives of this study were to estimate the prevalence of vitamin D deficiency and secondary hyperparathyroidism in both groups and to assess whether there is a relationship between obesity and vitamin D deficiency.

METHODS

This study was carried out in 138 patients in the Guadalajara University Hospital (Spain) between December 2008 and December 2009. Of these, 50.7% were morbidly obese and 49.3% were not obese. Fasting blood samples were taken from both groups for determination of 25-hydroxyvitamin D, intact parathyroid hormone, calcium, albumin and phosphorus, among other biochemical parameters.

RESULTS

The mean concentration of 25-hydroxyvitamin D was 16.6+/-8.12 ng/ml in the morbidly obese group and 21.9+/-7.34 ng/ml in the non-obese group (p<0.0001). The prevalence of vitamin D deficiency was 80% in morbidly obese patients and 41% in non-obese patients (p<0.0001). There were no statistically significant differences in concentrations of parathyroid hormone, calcium or phosphorus between the two groups.

CONCLUSIONS

A high prevalence of vitamin D deficiency was found in both groups studied, although the concentration of 25-hydroxyvitamin D was significantly lower in the morbidly obese. Morbid obesity is closely linked to vitamin D deficiency. To prevent this deficiency, determination of 25-hydroxyvitamin D should be included in clinical practice guidelines for the treatment of obesity.

[Vitamin D deficiency in women of reproductive age]

OBJECTIVE

To determine the level of hypovitaminosis D in adult healthy women attended in primary care and their associated factors.

DESIGN

Cross-sectional, descriptive study.

SETTING

A neighbourhood of Barcelona, Spain, with a socially deprived population with a high percentage of immigrants, and urban factors which meant that they lived with hardly any sunlight.

PARTICIPANTS

Women between 15-50 years seen between February and March 2005.

MEASUREMENTS AND RESULTS

Primary: residence time (years), skin phototype, sun exposure, vitamin D deficiency pain type, calcium, vitamin D consumed, and measurement of serum 25-hydroxyvitamin D (25[OH]D) or calcidiol and parathyroid hormone (PTH) if (25[OH]D) was <10 ng/mL; 94 women were included. Mean age: 33 years (SD, 7.8); 62.8% immigrants (mean years of residence, 11.5). Mean (25[OH]D), 14.0 ng/mL (95% CI, 12.5-15.5). Skin phototype V-VI was associated with low levels of (25[OH]D) (P=.001). None of the women stated that they consumed the recommended amount of vitamin D and only 46% the recommended amount of calcium. Sun exposure of >4 hours/week: 37%. Sixteen percent had musculo-skeletal pain. No relationship was found between vitamin D levels and immigration. All the women had (25[OH]D) levels of <40 mg/mL, 47.9% had insufficient (25[OH]D), 10-20 ng/mL, and 37.2% were deficient: pound10 mg/mL. PTH was within the normal range.

CONCLUSIONS

All the women had low levels of vitamin D, more than a third of these, deficient. No relationship with immigration was found. A relationship was established between skin phototype V-VI and (25[OH]D) deficiency. None of the cases consumed the recommended amounts of vitamin D.