老年糖尿病患者血清25-羟维生素D水平与代谢综合征、糖代谢、骨量的关系

目的探讨老年糖尿病患者血清25-羟维生素D[25(OH)D]水平与代谢综合征(MS)、糖代谢、骨量的关系。方法 100例年龄≥60岁的糖尿病患者为研究对象,以酶联免疫法测定其血清25(OH)D水平,并对糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)及空腹胰岛素(FINS)]水平及骨量指标[甲状旁腺激素(PTH)、骨密度、碱性磷酸酶(ALP)]水平进行测量,并通过体重指数(BMI)、血糖、血压、血脂等综合评价MS,观察25(OH)D与MS、糖代谢、骨量的关系。结果依据25(OH)D结果,25(OH)D缺乏组MS患者明显多于非25(OH)D缺乏组(P0.05);25(OH)D缺乏组FPG、HbA1c、FINS、PTH水平明显高于非25(OH)D缺乏组,骨密度明显低于非25(OH)D缺乏组(P0.05);两组2 h PG、ALP水平比较无显著差异(P0.05);Pearson相关性分析显示25(OH)D与MS、FPG、HbA1c、PTH及骨密度密切相关(P0.05)。结论老年糖尿病患者25(OH)D水平与MS、糖代谢异常及骨量流失之间有密切关联。     

非体力劳动者和退休人群维生素D营养状况及其与糖脂代谢的相关性分析

［摘要］　目的　探讨非体力劳动者和退休人群的维生素D营养状况,并分析其与糖脂代谢的相关性。方法　收集2019年5月至2019年8月在广西壮族自治区人民医院体检中心进行体检的受检者494名数据。均为企事业单位的非体力劳动者和退休人群。分析不同性别、年龄层间维生素D的营养状况差异。比较维生素D正常组和维生素D不足/缺乏组间在体质量指数（BMI）、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)的差异情况。分析血清总25-羟维生素D［25-(OH)D］水平与年龄、BMI、血糖和血脂的相关性。结果　494名受检者的血清总25-(OH)D的中位水平为71.68（56.37,87.44)nmol/L;其中维生素D正常者211名（42.71%）,不足/缺乏者共283例（57.29%）。男性血清总25-(OH)D水平高于女性,且维生素D营养状况为正常者的人数比例更高,差异有统计学意义（P<0.05）。18～45岁组、46～60岁组和>60岁组血清总25-(OH)D的中位水平分别为64.17（50.85,80.29）nmol/L、73.58（57.15,85.89）nmol/L和77.83（63.45,98.02）nmol/L,维生素D营养状况正常率分别为31.44%、46.67%和54.07%,差异均有统计学意义（P<0.05）。维生素D正常组与不足/缺乏组在BMI、FPG、TC、TG、HDL、LDL方面比较差异均无统计学意义（P>0.05）。血清总25-(OH)D水平与年龄呈正相关（r=0.266,P=0.000）,但与BMI、FPG、TC、TG、HDL、LDL相关性不显著（P>0.05）。结论　非体力劳动者和退休人群中维生素D不足和缺乏检出率高,建议非体力劳动者,尤其是室内办公职业人群、年轻女性要积极采取措施补充维生素D。     

中老年人不同季节血25羟维生素D水平变化及其与骨代谢关系的研究

目的探讨中老年人不同季节血25羟维生素D[25(OH)D]水平变化及其与骨代谢指标的关系。方法对2017-08～2018-08在内分泌代谢科就诊的117例绝经后女性及老年男性患者进行血清25(OH)D、电解质、甲状旁腺激素(PTH)、β胶原降解产物(β-CTX)及1型胶原氨基端延长肽(P1NP)检测。按照检测时间分为春组36例(3～5月份)、夏组32例(6～8月份)、秋组23例(9～11月份)、冬组26例(12～2月份),分析不同季节组血25(OH)D水平变化。同时,将患者按照25(OH)D水平分为维生素D缺乏组34例,25(OH)D50 nmol/L;维生素D不足组53例,50 nmol/L≤25(OH)D≤75 nmol/L;维生素D充足组30例,25(OH)D 75 nmol/L。分析各组电解质、PTH及骨转换指标的差异。结果春组与夏组、春组与秋组、夏组与冬组、秋组与冬组之间比较,25(OH)D差异有统计学意义(P0.01)。按维生素D水平分组的三组患者之间年龄、转氨酶、血肌酐、PTH、β-CTX差异均无统计学意义(P 0.05)。维生素D缺乏组与维生素D充足组比较,血钙(P0.01)、ln P1NP(P0.05)差异有统计学意义。各组25(OH)D水平与年龄呈负相关(P0.01)。结论中老年人夏季血25(OH)D水平高,冬季最低。在绝经后女性和老年男性患者中,25(OH)D与年龄呈负相关,25(OH)D缺乏的患者血钙水平下降,骨形成减少。     

老年高血压病患者颈动脉粥样硬化程度与血25-羟维生素D水平的相关性

目的　探讨老年高血压病患者颈动脉粥样硬化程度与血25-羟维生素D［25（OH）D］水平的相关性。方法　对2012年5月至12月间在宁波市第二医院就诊的老年高血压病患者经超声检测颈动脉内膜中膜厚度（IMT）,根据颈动脉IMT将患者分为颈动脉正常组（60例,对照组）、颈动脉内膜增厚组（60例）和颈动脉斑块组（60例）。采用ELISA法测定三组患者血清25（OH）D水平,分析25（OH）D水平与颈动脉IMT的关系。结果　颈动脉斑块组与颈动脉内膜增厚组血25（OH）D水平均低于颈动脉正常组（P<0.05）,颈动脉斑块组血25（OH）D水平低于颈动脉内膜增厚组（P<0.05）,差异均有统计学意义。结论　低血25（OH）D水平的老年高血压病患者具有颈动脉粥样硬化程度加重的危险,血25（OH）D水平测定有助于预测颈动脉粥样硬化程度。     

维持性血液透析患者维生素D缺乏的调查

目的:了解维持性血液透析(maintenancehemodialysis,MHD)患者维生素D的基线水平,并分析其与临床指标之间的相关性。方法:选取南京医科大学第二附属医院肾脏病中心278例MHD患者,ELISA方法检测患者血清25羟基-维生素D[25(OH)D]的水平,并用多元回归分析法分析25(OH)D水平与患者临床指标间的相关性,后者包括年龄、性别、体质量指数(bodymassindex,BMI)、血压、药物、原发病、透析龄、并发症以及生化指标如血钙、血磷、甲状旁腺激素等。结果:278例MHD患者(其中男175例,女103例)平均年龄为(57.4±18.2)岁,平均透析龄为(62.3±61.9)月。25(OH)D缺乏(<15ng/ml)和不足(15～30ng/ml)的患者分别占55%和37%,仅有8%的患者血清25(OH)D水平在正常范围内。进一步分析其与临床指标间的相关性发现,25(OH)D水平与女性、心血管并发症呈负相关(P<0.05),与男性、应用RAAS阻断剂呈正相关(P<0.05)。糖尿病患者25(OH)D水平低于非糖尿病患者,但无统计学差异。25(OH)D水平与年龄、BMI、血钙及甲状旁腺激素等无相关性。结论:维生素D缺乏和不足在MHD患者中发生率十分高,女性及心血管并发症的发生与之密切相关,应用RAAS阻断剂可能改善25(OH)D的缺乏和不足。     

自身免疫性甲状腺疾病患者血清25（OH）D3与sFas水平的相关性

目的探讨自身免疫性甲状腺疾病（AITD）患者血清25-二羟维生素D3[25（OH）D3]与sFas水平的关系。方法采用ELISA法和化学发光法检测47例Graves病患者（GD组）和42例桥本氏甲状腺机能减退患者（HT组）血清25（OH）D3、sFas、甲状腺功能指标及甲状腺自身相关抗体TPOAb、TGAb,并进行相关性分析;另选45例年龄和性别相匹配的健康者作为正常组。结果 GD组血清sFas水平明显高于HT组及正常组;GD组及HT组血清25（OH）D3水平均明显低于正常组。GD组血清25（OH）D3水平与sFas、TPOAb、TGAb呈显著负相关,血清sFas水平与TPOAb、TGAb呈正相关;HT组血清25（OH）D3水平与sFas、TPOAb、TGAb呈显著负相关,与FT4呈正相关,血清s Fas水平与TPOAb、TGAb、FT3呈正相关;P均〈0.01。结论自身免疫性甲状腺疾病患者患者存在低25（OH）D3血症及异常sFas表达;AITD患者血清25（OH）D3与sFas存在相关性,25（OH）D3可调节sFas的表达。     

2型糖尿病患者血清25-羟维生素D水平的调查与分析

目的调查2型糖尿病(T2DM)患者血清25-羟维生素D[25(OH)D]水平,并分析25(OH)D和糖尿病之间的相关性。方法选择2016年10月-2018年9月期间该院收治的80例T2DM患者并作为试验组,另选择同期体检健康的志愿者100名作为对照组,检测两组入选对象血清25(OH)D水平及相关临床及生化指标。结果试验组病例25(OH)D低于对照组,FBG、SDP、SBP、BUN、TG水平高于对照组,差异有统计学意义(P<0.05);将试验组病例分为不同年龄组,发现男、女性年龄≥70岁年龄组25(OH)D水平最高,分别为(39.69±17.33)mmol/L、(38.04±16.55)mmol/L,相同年龄段中男女25(OH)D水平差异有统计学意义(P<0.05);且相关性分析表明,25(OH)D水平和空腹血糖之间存在负相关性(P<0.05)。结论T2DM患者血清25(OH)D水平低于正常者,通常情况下年龄越大25(OH)D水平越高;空腹血糖水平越高,25(OH)D水平越低。     

血清25羟-维生素D、碘营养状况与自身免疫性甲状腺病的相关性

目的探讨25羟-维生素D[25(OH)D]水平、碘营养状况和自身免疫性甲状腺疾病(AITD)的相关性。方法通过检测380例粤中西部地区居民的空腹血清25(OH)D水平、甲状腺功能、甲状腺自身抗体、尿碘等相关指标等,并比较25(OH)D缺乏患者治疗后相关指标的差异,分析血清25(OH)D、碘营养状况对AITD发病的影响。结果 Graves病(GD)组、桥本甲状腺炎(HT)组25(OH)D3水平显著低于健康对照组(P<0.05)。GD组血清25(OH)D3水平与促甲状腺激素受体抗体(TRAb)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)呈显著负相关,与促甲状腺激素(TSH)呈显著正相关(P<0.01,P<0.05)。HT组血清25(OH)D3水平与抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)、TSH呈显著负相关,与FT3、FT4呈显著正相关(P<0.01,P<0.05)。在GD组应用甲巯咪唑和HT组应用左甲状腺素的基础上加用活性维生素D连续治疗3个月后,GD组TRAb抗体水平明显降低,HT组TGAb、TPOAb抗体水平也明显降低(均P<0.05)。GD组和HT组尿碘中位数均较对照组高。尿碘高的AITD患者25(OH)D3水平缺乏更明显(P<0.05)。结论 AITD初发患者伴低维生素D水平,其中尿碘高的AITD患者25(OH)D3水平缺乏更明显。补充活性维生素D可降低其自身抗体水平。     

新疆维吾尔族、哈萨克族和汉族高血压人群维生素D水平的现况调查

目的了解新疆维吾尔族、哈萨克族和汉族高血压患者维生素D水平的状况及民族差异性。方法采用随机抽样的方法,抽取喀什、阜康、乌鲁木齐地区的原发性高血压患者3318例(汉族1332例,维吾尔族1011例,哈萨克族975例),采用电化学发光法检测血清25羟基维生素D[25(OH)D]浓度;血清25(OH)D30nmol/L为维生素D缺乏;30~50nmol/L为维生素D不足;≥50nmol/L为维生素D充足。结果新疆不同民族高血压患者血清25(OH)D水平存在差异,哈萨克族血清25(OH)D高于汉族,汉族血清25(OH)D高于维吾尔族[(38.05±20.02)比(35.63±18.37)比(25.45±18.67)nmol/L,均P0.05]。3318例高血压患者中,血清25(OH)D缺乏占50.45%,不足占31.80%,充足仅为17.75%。男性血清25(OH)D水平高于女性[(35.68±18.50)比(30.80±20.58)nmol/L,P0.05]。青年(45岁)、中年(45~65岁)和老年(≥65岁)组之间血清25(OH)D水平差异无统计学意义。多因素Logistic回归分析显示,25(OH)D水平与收缩压呈负相关(OR=0.912,95%CI 0.855~0.973)。结论新疆哈萨克族、维吾尔族、汉族高血压患者血清25(OH)D缺乏普遍存在,且存在民族差异性,25(OH)D水平与收缩压呈负相关。     

2型糖尿病患者维生素D缺乏的调查分析

目的 调查分析2型糖尿病患者血清25羟维生素D3[25（OH）D3]的水平和缺乏程度,初步了解维生素D缺乏与糖尿病病程和糖化血红蛋白（HbA1c）的关系.方法 选择天津医科大学总医院2型糖尿病患者140例,其中男60例,女80例,年龄21～89岁,平均（58.25±13.76）岁.分析不同年龄组即＜50岁、≥50且＜70岁、≥70岁者,不同检测季节组即冬春季和夏秋季两组,不同糖尿病病程组即＜10年、≥10且＜20年、≥20年,及不同HbA1c水平组即＜7％、≥7％且＜10％、≥10％的血清25（OH）D3水平.结果 （1）140例患者血清25（OH）D3水平均明显降低[（40.07±16.12）nmol/L],维生素D严重缺乏者占13.57％,缺乏者占67.86％,充足者仅占4.29％,不同性别患者维生素D水平和缺乏程度的差异均无统计学意义（t =0.803,x2=0.189,P均＞0.05）.（2）男性≥50且＜70岁组25（OH）D3水平较＜50岁组明显降低（F=2.362,P＜0.05）;女性≥50岁的两组患者25（OH）D3水平均较＜50岁组明显降低（F =3.928,P＜0.05）,维生素D缺乏者的比例均较＜50岁组显著增多（x2=10.036,P ＜0.01）.（3）冬春季组25（OH）D3水平显著低于夏秋季组（t=-4.681,P＜0.01）,严重缺乏者和缺乏者的比例也明显增加（x2=18.202,P＜0.01）.（4）病程≥10年的两组患者25（OH）D3水平均较＜10年组明显下降（F =5.489,P＜0.05）,≥20年组严重缺乏者的比例也多于＜10年组（x2=7.284,P＜0.05）.（5）HbA1c≥7％的两组患者25（OH）D3水平均较＜7％组明显下降（F=3.963,P均＜0.01）,其严重缺乏者和缺乏者的比例也较＜7％组明显增加（x2=6.712,P＜0.05）.结论 2型糖尿病患者普遍存在维生素D缺乏,尤其是病程长和持续血糖控制不佳者,特别需加强冬季维生素D的检测和补充.     

绝经后妇女25羟基维生素D浓度及其与甲状旁腺素和骨转换指标关系548例研究

目的探讨健康绝经后妇女25羟基维生素D[25(OH)D]缺乏状况及与甲状旁腺素(PTH)和骨转换指标值的关系。方法筛选2010年2—3月上海市徐汇区548例绝经后健康妇女,平均年龄为(63.6±6.5)岁。受试者按照25(OH)D浓度分为维生素D严重缺乏组(<24 nmol/L)、维生素D缺乏组(24～<48 nmol/L)、维生素D不足组(48～<72 nmol/L)和维生素D充足组(≥72 nmol/L)。检测空腹血25(OH)D、PTH和各骨转换指标包括1型胶原羧基末端肽β降解产物(β-CTX)、全端骨钙素(OC)和1型原胶原氨基端前肽(P1NP)。结果 184例(33.6%)为严重缺乏,251例(45.9%)为缺乏,30例(5.5%)为不足和82例(15.0%)为充足。进一步分析各组间年龄、体重指数(BMI)、PTH和各骨转换指标水平的差异,发现各组年龄和BMI差异无统计学意义,但随着25(OH)D浓度下降,PTH、β-CTX、OC和P1NP水平逐步增加,与≥72 nmol/L组比较,其他3组上述各指标水平差异有统计学意义。25(OH)D浓度与PTH及各转换指标呈显著的负相关(P均<0.01)。结论在冬季上海市健康绝经后妇女维生素D缺乏非常普遍,随之引起血PTH水平和骨转换指标的明显增加,临床必须加以重视。     

Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study

BACKGROUND: Primary hyperparathyroidism (PHPT) is associated with reduced plasma 25-hydroxyvitamin D (P-25OHD) and usually increased plasma 1alpha,25-dihydroxyvitamin D (P-1,25(OH)2D). Parathyroid tissue expresses the vitamin D receptor and it is thought that circulating 1,25(OH)2D participate in the regulation of parathyroid cell proliferation, differentiation and secretion. AIM: To investigate the relations between circulating levels of 1,25(OH)2D and 25OHD respectively and parathyroid adenoma weight (AW), plasma-parathyroid hormone (P-PTH) and PTH secretion expressed as P-PTH/AW. DESIGN: Cross-sectional study. MATERIAL: One hundred and seventy-one consecutive hypercalcaemic caucasian patients aged 19-87 years (median 63, 84% females) with surgically proven parathyroid adenoma. RESULTS: A weak positive correlation was found between P-25OHD and P-1,25(OH)2D (r=0.24, P<0.005). AW depended on sex and body mass index. Following adjustment, it was correlated positively to P-PTH, calcium (Ca) and alkaline phosphatase (AP) and inversely to plasma phosphate in a multiple regression model. AW was not associated with vitamin D metabolites. Preoperative P-PTH correlated positively to plasma levels of Ca and AP, but inversely to phosphate and 25OHD (P<0.001) levels. P-PTH was not associated with P-1,25(OH)2D (P=0.65). The P-PTH:AW ratio correlated inversely to P-25OHD (P<0.05), but showed no relations to plasma levels of Ca, phosphate or 1,25(OH)2D (P=0.22). CONCLUSION: In this material, low levels of 25OHD were related to higher levels of P-PTH and higher PTH:AW ratios in patients with PHPT suggesting that vitamin D deficiency increase PTH secretion activity. Neither PTH secretion nor AW was associated with circulating levels of 1,25(OH)2D.     

Parathormone,vitamin D and the risk of atrial fibrillation in older adults: A prospective study

Background & aimsVitamin D and parathormone (PTH) have been associated with cardiovascular outcomes, but their impact on atrial fibrillation (AF) onset is still unclear. We explored the influence of serum 25-hydroxyvitamin D (25[OH]D) and PTH on AF risk in older adults.Methods and resultsData come from 2418 participants enrolled in the Progetto Veneto Anziani study. Serum 25(OH)D and intact PTH were measured using radioimmunoassay and two-site immunoassay, respectively. The associations between 25(OH)D, PTH and adjudicated AF cases over 4-years were explored by Cox regression.Over the follow-up, 134 incident cases of AF were assessed. The incidence rate of the sample was 13.5 (95%CI 11.4–15.9) per 1000 person-years, and was higher among those with high PTH levels (high: 16.4 [95%CI 11.3–24.0] per 1000 person-years), especially when associated to low 25(OH)D (20.3 [95%CI 12.9–32.3] per 1000 person-years). At Cox regression, only high PTH was significantly associated to an increased risk of AF (HR = 1.90, 95%CI 1.27–2.84). A marginal significant interaction (p = 0.06) was found between 25[OH]D and PTH concentrations in influencing AF risk. When exploring the risk of AF for combined categories of 25(OH)D and PTH, we found that those with high PTH and low 25(OH)D levels had an AF risk twice as high as that of people with normal values (HR = 2.09, 95%CI 1.28–3.42).ConclusionThe risk of AF may be increased by high PTH levels, especially when associated with 25(OH)D deficiency. The identification and treatment of high PTH or vitamin D deficiency may thus contribute to lower the risk of AF.     

Vitamin D deficiency in children and adolescents with type 1 diabetes

Objective: To investigate the frequency and effects of vitamin D deficiency in children with type 1 diabetes (T1D) in a region which is known to have a high rate of vitamin D deficiency among adolescents. Methods: In this prospective cross-sectional study, 120 children and adolescents with T1D (55 girls and 65 boys) aged 3-20 years were evaluated. Serum 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), and alkaline phosphatase (ALP) levels were measured. Hemoglobin A1c levels and daily insulin requirement were also evaluated. Classification of vitamin D status was made according to the American Academy of Pediatrics (AAP)/LWEPS’s recommendations. The patients were divided into 2 groups according to their vitamin D status and also according to the season of the year in which 25(OH)D sampling was done. Results: Serum 25(OH)D levels revealed vitamin D deficiency or insufficiency in 38% of the patients. Higher PTH levels were found in the patient group whose mean 25(OH)D level was <20 ng/mL as compared to the group whose mean 25(OH)D level was >20 ng/mL (p<0.05). Only 11% of patients had secondary hyperparathyroidism. The 25(OH)D levels of patients whose serum samples were taken in summer and spring months were significantly different (p<0.05). There were no significant correlationsbetween 25(OH)D level and daily insulin dose. Conclusion: Although we could not show a significant association between vitamin D deficiency and metabolic parameters, the frequency of vitamin D deficiency in T1D children is substantial. Vitamin D status should be assessed also in patients who do not have signs of rickets.Conflict of interest:None declared.     

Short and long-term variations in serum calciotropic hormones after a single very large dose of ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) in the elderly

CONTEXT: In humans, few studies have compared the potencies of ergocalciferol and cholecalciferol in improving and maintaining vitamin D status. OBJECTIVE: Our objective was to evaluate the effects of a single very large dose of both calciferols on serum changes of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], ionized calcium, and parathyroid hormone (PTH) at baseline, and at 3, 7, 30, and 60 d. DESIGN: This was a prospective randomized intervention study. SETTING: The study was performed in a nursing home residence. PARTICIPANTS: A total of 32 elderly female patients (age range 66-97 yr), with vitamin D deficiency was included in the study. INTERVENTION: Participants were randomized into four groups of eight to receive a single dose of 300,000 IU ergocalciferol or cholecalciferol by oral (os) or im route. RESULTS: 25(OH)D levels sharply increased at d 3 only when vitamins were given os. The 30-d basal difference in serum 25(OH)D was significantly greater after cholecalciferol os administration (47.8 +/- 7.3 ng/ml) compared with other forms (D(3) im: 15.9 +/- 11.3; D(2) os: 17.3 +/- 4.7; D(2) im: 5 +/- 4.4; all P < 0.001). The area under the curve (AUC) of the serum 25(OH)D against time (AUC(60)) was: D(3) os, 3193 +/- 759 ng x d/ml vs. D(2) os, 1820 +/- 512, P < 0.001; and D(3) im, 1361 +/- 492 vs. D(2) im, 728 +/- 195, P < 0.01. 25(OH)D significantly influences PTH levels at 3 (P < 0.03), 7 (P < 0.01), 30 (P < 0.01), and 60 d (P < 0.05). At 60 d, the form of vitamin (cholecalciferol) significantly lowers PTH levels (P = 0.037). CONCLUSIONS: Cholecalciferol is almost twice as potent as ergocalciferol in increasing serum 25(OH)D, when administered either by mouth or im. 25(OH)D plays a role in modulating serum PTH.     

Effects of Lowering Dialysate Calcium Concentration on Bone Metabolic Markers in Hemodialysis Patients With Suppressed Serum Parathyroid Hormone: A Preliminary Study

Although the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a dialysate calcium concentration between 2.5 and 3.0 mEq/L, its optimal concentration remains unclear. A total of 53 hemodialysis patients with intact parathyroid hormone (PTH) levels <150 pg/mL were enrolled in this prospective observational study. A dialysate calcium concentration was converted from 3.0 to 2.75 mEq/L and bone metabolic markers including bone alkaline phosphatase (BAP) and tartrate‐resistant acid phosphatase‐5b (TRACP‐5b) were examined. After 3 months, serum corrected calcium levels decreased (P < 0.001), while serum intact PTH, BAP and TRACP‐5b levels increased (P < 0.05, P < 0.05 and P < 0.001, respectively). Multiple regression analyses showed that the amount of change in BAP was significantly associated with dialysis vintage (P < 0.01). In conclusion, the lowering of dialysate calcium concentration stimulated parathyroid gland and bone remodeling in hemodialysis patients with suppressed PTH, particularly with longer dialysis vintage.     

SERUM LEVELS OF 25-HYDROXYVITAMIN D, 24,25-DIHYDROXYVITAMIN D AND PARATHYROID HORMONE IN PATIENTS WITH FEMORAL NECK FRACTURE IN SOUTHERN FINLAND

Serum concentrations of 25-hydroxyvitamin D (25-OHD), 24,25-dihydroxy-vitamin D [24,25(OH)2D] and immunoreactive parathyroid hormone (PTH) were determined in elderly patients with fracture of the femoral neck and in age-matched controls during summer, winter and early spring in southern Finland. The expected seasonal variation in 25-OHD values was observed in both patients and controls, though the patient group had significantly lower values during winter (P < 0.02) and spring (P < 0.01). The 24,25(OH)₂D: 25-OHD ratio remained constant in both patients and controls throughout the study. A significant negative correlation between PTH and 25-OHD values was found in the patient group. Thus, vitamin D deficiency may contribute to the high incidence of femoral neck fractures in elderly people, and the increased PTH activity, observed in many patients with these fractures, is secondary to vitamin D deficiency.     

The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population

Vitamin D deficiency is commonly found in the elderly and is associated with osteoporosis and hip fractures. In this study, Vitamin D status of 138 female and 87 male subjects living in old age homes (OAH) and 171 female and 24 male subjects living in own homes (OH) from Central Anatolia were assessed. A questionnaire was applied to collect information about wearing features and degree of sunlight exposure and benefiting from ultraviolet index calculated (BFUI). We have found Vitamin D deficiency in 33.4% among our subjects. Also, 40.1% of subjects living in OAH (54.1% of females and 18.4% of males) and 24.4% of subjects living in OH (27.9% of females and 4.2% of males) were Vitamin D deficient. Vitamin D deficiency was significantly higher in subjects living in OAH than subjects living in OH (P = 0.001) and also higher in females than males (40.7% versus 15.3%, P < 0.001). Subjects with Vitamin D deficiency were older (P < 0.001), BFUI was lower (P < 0.001) and parathyroid hormone (PTH) was higher (P < 0.001) than those having normal level of 25(OH)D. There was a significant negative correlation between 25(OH)D levels and age (P < 0.001, r = -0.248) PTH and 25(OH)D (P = 0.004, r = -0.340), and positive correlation between 25(OH)D and BFUI (P < 0.001, r = 0.340). Vitamin D deficiency is very common in Turkish elderly subjects especially living in OAH and there is a significant low exposure to sunlight among them. Simply by asking clothing habits and exposure to sunlight, we can able to identify risk of Vitamin D insufficiency in elderly subjects.     

Vitamin D status and measurements of markers of bone metabolism in patients with small intestinal resection

BACKGROUND AND AIMS: Vitamin D deficiency is common in patients with small intestinal resection and may lead to secondary hypersecretion of parathyroid hormone (PTH), which in turn may result in increased bone turnover rate and loss of bone mineral. The aims of this study were to investigate the prevalence of vitamin D deficiency, as assessed by low serum concentrations of 25-hydroxyvitamin D (25(OH)D) in patients with small intestinal resection and to explore the relation of 25(OH)D to PTH, markers of bone turnover rate, and bone mineral density (BMD) in these patients. PATIENTS: Forty two patients with small intestinal resection, a faecal energy excretion of more than 2.0 MJ/day, and a mean length of the remaining small intestine of 199 cm were included. Diagnoses were Crohn's disease (n=35) and other (n=7). METHODS: 25(OH)D was analysed by radioimmunoassay and bone turnover rate was assessed by measurement of serum osteocalcin, serum alkaline phosphatase, urine pyridinoline, and urine deoxypyridinoline. BMD was measured by dual energy x ray absorptiometry. RESULTS: Mean 25(OH)D concentration was 13.4 (SD 9.7) ng/ml, which was significantly below the reference mean of 26.4 (SD 13.2) ng/ml (p<0.001). Vitamin D deficiency (25(OH)D concentration 相似文献