Vitamin D deficiency is associated with cortical bone loss and fractures in the elderly

Introduction The role of vitamin D on bone microarchitecture and fragility is not clear. Objective To investigate whether vitamin D deficiency (25(OH)D <20 ng/mL) increases cortical bone loss and the severity of fractures. Design Cross-sectional study of 287 elderly women with at least one prevalent low-impact fracture. Methods Biochemistry, X-rays to identify vertebral fractures (VFs) and to confirm non-vertebral fractures (NonVFs), and high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone microstructure. Results Serum 25(OH)D levels were associated with body mass index (BMI: r = −0.161, P = 0.006), PTH (r = −0.165; P = 0.005), CTX (r = −0.119; P = 0.043) and vBMD at cortical bone (Dcomp: r = 0.132; P = 0.033) and entire bone (D100: r = 0.162 P = 0.009) at the distal radius, but not at the tibia. Age and PTH levels were potential confounding variables, but in the multiple linear regressions only BMI (95% CI: 0.11–4.16; P < 0.01), 25(OH)D (95% CI: −0.007 to 1.70; P = 0.05) and CTX (95% CI: −149.04 to 21.80; P < 0.01) predicted Dcomp, while BMI (95% CI: 1.13–4.18; P < 0.01) and 25(OH)D (95% CI: 0.24–1.52; P < 0.01) predicted D100. NonVFs predominated in patients with 25(OH)D <20 ng/mL (P = 0.013). Logistic regression analysis showed a decrease in the likelihood of presenting grade 2–3 VFs/NonVFs for every increase in 25(OH)D (OR = 0.962, 95% CI: 0.940–0.984; P = 0.001), BMI (OR = 0.932, 95% CI: 0.885–0.981; P = 0.007) and D100 at radius (OR = 0.994, 95% CI: 0.990–0.998; P = 0.005). Conclusion In elderly patients with prevalent fractures, vitamin D deficiency was associated with cortical bone loss and severity of fractures.

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Vitamin D Receptor Genotype Is Associated with Cortical Bone Loss in Japanese Patients with Primary Hyperparathyroidism.

Endocrine Journal ◽

10.1507/endocrj.45.123 ◽

1998 ◽

Vol 45 (1) ◽

pp. 123-125 ◽

Cited By ~ 10

Author(s):

TATSUYA KOBAYASHI ◽

TOSHITSUGU SUGIMOTO ◽

AKIRA KOBAYASHI ◽

KAZUO CHIHARA

Keyword(s):

Vitamin D ◽

Bone Loss ◽

Primary Hyperparathyroidism ◽

Cortical Bone ◽

Vitamin D Receptor ◽

Japanese Patients ◽

Cortical Bone Loss

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Bone Microarchitecture Assessment by High-Resolution Peripheral Quantitative Computed Tomography in Patients with Systemic Lupus Erythematosus Taking Corticosteroids

The Journal of Rheumatology ◽

10.3899/jrheum.091231 ◽

2010 ◽

Vol 37 (7) ◽

pp. 1473-1479 ◽

Cited By ~ 24

Author(s):

EDMUND K. LI ◽

TRACY Y. ZHU ◽

LAI-SHAN TAM ◽

VIVIAN W. HUNG ◽

JAMES F. GRIFFITH ◽

...

Keyword(s):

Vertebral Fracture ◽

Bone Density ◽

Cortical Bone ◽

Vertebral Fractures ◽

Lupus Erythematosus ◽

Bone Microarchitecture ◽

Quantitative Computed Tomography ◽

Peripheral Quantitative Computed Tomography ◽

Cortical Bone Density ◽

Chronic Corticosteroid

Objective.We assessed the relationship between vertebral fracture and bone microarchitecture in patients with systemic lupus erythematosus (SLE) on chronic corticosteroid therapy using high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods.Fifty-nine Chinese women with SLE taking corticosteroid were selected to participate in a cross-sectional study. Vertebral fracture was confirmed semiquantitatively by lateral radiographs of the thoracic and lumbar spine. Density and microarchitecture at the distal radius were measured with HR-pQCT. Areal bone mineral density (aBMD) at hip and lumbar spine was measured by dual-energy x-ray absorptiometry (DEXA).Results.Twelve patients had vertebral fractures. The aBMD of spine or hip did not differ between those with and without vertebral fractures. Measures by HR-pQCT revealed that patients with vertebral fractures had significantly lower level of average bone density (p = 0.007), cortical bone density (p = 0.029), trabecular bone density (p = 0.024), trabecular bone volume to tissue volume (p = 0.023), and trabecular thickness (p = 0.011) than those without vertebral fractures. Independent explanatory variables associated with higher risk of vertebral fractures were older age (p = 0.013) and lower average cortical bone density (p = 0.029).Conclusion.Vertebral fracture in patients with SLE on chronic corticosteroid treatment was associated with alterations of bone density and microarchitectures measured by HR-pQCT and DEXA. However, alterations were more pronounced in measurements by HR-pQCT. Low cortical bone density and old age were significant predictors of vertebral fracture risk.

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Cortical bone loss at the tibia in postmenopausal women with osteoporosis is associated with incident non-vertebral fractures: Results of a randomized controlled ancillary study of HORIZON

Maturitas ◽

10.1016/j.maturitas.2013.12.013 ◽

2014 ◽

Vol 77 (3) ◽

pp. 287-293 ◽

Cited By ~ 3

Author(s):

A.W. Popp ◽

H. Buffat ◽

A. Cavelti ◽

M. Windolf ◽

R. Perrelet ◽

...

Keyword(s):

Bone Loss ◽

Cortical Bone ◽

Postmenopausal Women ◽

Vertebral Fractures ◽

Cortical Bone Loss ◽

Ancillary Study ◽

Randomized Controlled

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Parathyroid Hormone-Related Changes of Bone Structure

Physiological Research ◽

10.33549/physiolres.934779 ◽

2021 ◽

pp. S3-S11

Author(s):

M. Kužma ◽

P. Jackuliak ◽

Z. Killinger ◽

J. Payer

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Trabecular Bone ◽

Cortical Bone ◽

Vertebral Fractures ◽

Bone Structure ◽

Trabecular Bone Score ◽

Quantitative Computed Tomography ◽

Indirect Measure ◽

Increased Risk

Parathyroid hormone (PTH) increases the release of serum calcium through osteoclasts, which leads to bone resorption. Primary, PTH stimulates osteoblasts leading to increase RANKL (receptor activator for nuclear factor kappa-B ligand) expression and thus differentiation of osteoclasts. In kidneys, PTH increases calcium and decrease phosphate reabsorption. In kidneys, PTH stimulates 1alpha-hydroxylase to synthesize active vitamin D. Primary hyperparathyroidism (PHPT) is characterized by skeletal or renal complications. Nowadays, the classical form of PHPT is less seen and asymptomatic or subclinical (oligo symptomatic) forms are more frequent. Previously, it was thought that cortical bone is preferably affected by PHPT and that predispose bones to fracture at sites with a higher amount of cortical bone. However, an increased risk of vertebral fractures has been found by most of the studies showing that also trabecular bone is affected. Bone Mass measurement (BMD) at all skeletal sites is advised, but another specific tool for fracture assessment is needed. Trabecular bone score (TBS), an indirect measure of trabecular bone, maybe a useful method to estimate fracture risk. TBS is associated with vertebral fractures in PHPT regardless of BMD, age, BMI and gender. Furthermore, there is an association between TBS and high resolution peripheral quantitative computed tomography (HR-pQCT) parameters in the trabecular and cortical compartment. However, studies considering the effect of PHPT treatment on TBS are more conflicting. Secondary hyperparathyroidism caused by vitamin D deficiency was associated with impaired bone microarchitecture in all age categories, as measured by TBS and Hr-pQCT with further improvement after treatment with vitamin D.

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Calcium and vitamin D reduced non-vertebral fractures and bone loss in the elderly

Evidence-Based Nursing ◽

10.1136/ebn.1.2.48 ◽

1998 ◽

Vol 1 (2) ◽

pp. 48-48

Author(s):

J. Dewing

Keyword(s):

Vitamin D ◽

Bone Loss ◽

Vertebral Fractures ◽

The Elderly

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Supportive Role of Probiotic Strains in Protecting Rats from Ovariectomy-Induced Cortical Bone Loss

Probiotics and Antimicrobial Proteins ◽

10.1007/s12602-018-9443-6 ◽

2018 ◽

Vol 11 (4) ◽

pp. 1145-1154 ◽

Cited By ~ 14

Author(s):

Nima Montazeri-Najafabady ◽

Younes Ghasemi ◽

Mohammad Hossein Dabbaghmanesh ◽

Pedram Talezadeh ◽

Farhad Koohpeyma ◽

...

Keyword(s):

Bone Loss ◽

Cortical Bone ◽

Cortical Bone Loss ◽

Supportive Role ◽

Probiotic Strains

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Craniotabes in Normal Newborns: The Earliest Sign of Subclinical Vitamin D Deficiency

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2254 ◽

2008 ◽

Vol 93 (5) ◽

pp. 1784-1788 ◽

Cited By ~ 71

Author(s):

Junko Yorifuji ◽

Tohru Yorifuji ◽

Kenji Tachibana ◽

Shizuyo Nagai ◽

Masahiko Kawai ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Urinary Calcium ◽

University Hospital ◽

X Rays ◽

Intact Pth ◽

Calcium Phosphorus ◽

Serum Pth ◽

Normal Neonates ◽

Breast Fed

Abstract Context: Craniotabes in otherwise normal neonates has been regarded as physiological and left untreated. Objective: Our objective was to investigate the role of vitamin D deficiency in the development of craniotabes in normal neonates. Design and Setting: Newborn screening of craniotabes was conducted at the single largest obstetrical facility in Kyoto, Japan. Follow-up study at 1 month was conducted at Kyoto University Hospital. Subjects: A total of 1120 consecutive normal Japanese neonates born in May, 2006, through April, 2007, were included in the study. Main Outcome Measures: The incidence of craniotabes was scored each month. Neonates with craniotabes were followed up at 1 month with measurements of serum calcium, phosphorus, alkaline phosphatase (ALP), intact PTH, 25-OH vitamin D (25-OHD), urinary calcium, phosphorus, creatinine, and hand x-rays. Results: Craniotabes was present in 246 (22.0%) neonates, and the incidence had obvious seasonal variations, highest in April-May and lowest in November. At 1 month, infants with craniotabes had significantly higher serum ALP compared with normal neonates; 6.9% of them had elevated intact PTH over 60 pg/ml, and 37.3% had 25-OHD less than 10 ng/ml. When separately analyzed according to the method of feeding, 56.9% of breast-fed infants showed 25-OHD less than 10 ng/ml, whereas none of formula/mixed-fed infants did, and breast-fed infants had significantly higher serum PTH and ALP compared with formula/mixed-fed infants. Summary: These results suggest that craniotabes in normal neonates is associated with vitamin D deficiency in utero, and the deficiency persists at 1 month in many of them, especially when breast-fed.

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