Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly

ABSTRACT Objective To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. Materials and methods Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. Results In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). Conclusion The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.

【摘要】研究目的：比较养老院入住长者与社区居住老年受试者的维生素D缺乏患病率及骨折史，并探讨维生素D水平与各项临床特征的关联。研究对象与方法：本研究共纳入66名养老院入住长者及139名社区居住老年受试者。收集受试者的婚姻状况、病史、包括维生素D补充剂在内的用药情况、吸烟史及既往骨折史。测量身高、体重并计算体重指数（Body Mass Index, BMI）。检测血清25-羟维生素D（25-hydroxyvitamin D, 25-OHD）、甲状旁腺素（Parathyroid Hormone, PTH）、钙（Ca）、磷酸盐、肌酐及估算肾小球滤过率（estimated glomerular filtration rate, eGFR）。研究结果：养老院入住长者的25-OHD水平更低（17.8 nmol/L，[9.4-28.6] vs. 36.7 nmol/L，[26.9-50]，p<0.001），PTH水平更高（5.6 pmol/L，[3.9-8.9] vs. 4.7 pmol/L，[3.6-5.8]，P=0.003）；维生素D缺乏的患病率更高（65.2% [53.7-76.7] vs. 22.3% [15.4-29.2]，p<0.001），甲状旁腺素升高的患病率也更高（23% [12.8-33] vs. 5.8% [2-10]，p=0.001）。25-OHD与PTH呈负相关（机构化组r=-0.28，p=0.025；社区组r=-0.36，p<0.001）。8%的养老院长者报告有髋部骨折史，社区独立老年受试者的髋部骨折史比例为2%。髋部骨折的唯一预测因素为PTH升高（OR=7.6（1.5-36.9），p=0.013）。研究结论：养老院入住长者的维生素D缺乏及继发性甲状旁腺功能亢进症患病率较高。髋部骨折风险与PTH升高相关，而非直接与维生素D水平或居住身份相关。