中老年女性血清25羟维生素D水平与骨密度、体质量指数的调查研究

目的调查深圳市中老年女性人群血清25羟维生素D水平、骨密度(bone mineral density,BMD)和体质量指数(body mass index,BMI)并探讨其相关性,为骨质疏松症(osteoporosis,OP)的防治提供相应的依据。方法收集2018年10月至2019年2月于深圳平乐骨伤科医院(坪山区中医院)参与调查的中老年女性212例[年龄50～84岁,平均(60. 1±7. 8)岁],测量受试者的身高、体重,计算BMI,根据BMI分成体重过低组(6例)、正常体重组(112例)和超重组(94例),分别测量各组骨密度和血清25羟维生素D水平。采用Spearman相关分析观察指标间的相关性。结果体重过低组、正常体重组和超重组三组的OP患病率依次为:83. 3%、58. 0%和57. 4%,三组的差异不具有统计学意义(P0. 05)。正常体重组的25羟维生素D与BMD、BMI均不存在相关关系(P0. 05),BMD与年龄的关系呈负相关,与身高、体重均呈正相关(P0. 05),但是与BMI之间则不存在相关性(P0. 05)。在超重组中,25羟维生素D与BMI呈负相关,BMD与年龄呈负相关,与身高呈正相关(P0. 05),但是与体重、BMI之间的相关性无统计学意义(P0. 05)。结论在BMI正常范围内,高体重是OP的保护因素,而超重时则不存在此关系。且超重对中老年女性的血清25羟维生素D水平可产生负面影响。过重的体重可能不利于OP的防治,中老年女性应控制体重在正常范围内。     

3 326例南京地区人群维生素D水平与季节关系调查

目的通过测定江苏省中医院2017年就诊患者体内25羟维生素D[25(OH)D]水平,分析目前维生素D水平状况并评价其与季节的关系。方法收集2017年1月1日至2017年12月31日在江苏省中医院测25(OH)D水平的门诊及住院患者3 326例,主要来源于内分泌科、生殖医学科、体检中心等就诊的南京市居民,排除相关影响因素,分别比较不同季节、性别的25(OH)D水平和维生素D营养状况差异。结果 3 326例患者的25(OH)D的平均水平为18.38 ng/mL,维生素D缺乏率为63.3%,不足率为29.0%,正常率为7.7%;春夏两季维生素D水平高于秋冬两季(P0.05);女性维生素D水平明显低于男性(P0.05)。结论南京地区人群存在不同程度的维生素D缺乏,且具有季节差异性,秋冬季节25(OH)D的水平更低,与性别也相关联。维生素D作为人体内不可缺少的维生素对骨骼系统具有重要作用,提高公众合理补充维生素D的意识并针对高危人群及时补充钙剂是必要的,定期检测25(OH)D作为评估体内维生素D水平的常规实验室检查,为临床正确应用维生素D提供科学的理论依据。     

孕妇血清25羟基维生素D水平与妊娠合并症的关系

维生素D是一种脂溶性类固醇激素,通过其循环活性形式25羟基维生素D(25OHD)在人体中发挥作用。维生素D可调节机体钙磷平衡,维持骨骼健康,对人体免疫调节、葡萄糖代谢、细胞增殖等生理过程均有重要作用。孕期女性血清25OHD的缺乏主要由于日照不足和摄入过少导致。25OHD的水平与妊娠合并症(如妊娠高血压、子痫前期和妊娠糖尿病)密切相关,25OHD的缺乏与妊娠高血压和子痫前期呈显著正相关,与妊娠糖尿病则呈负相关。本文就25OHD与妊娠合并症的关系进行综述。     

未绝经女性甲亢患者血25羟维生素D水平与骨密度的关系

目的 观察未绝经女性甲亢患者骨密度及血钙、血磷、血碱性磷酸酶（ALP）、血浆25羟维生素D[25(OH)D]、血浆甲状旁腺激素（PTH）水平变化,分析未绝经女性甲亢患者血浆25(OH)D与骨密度的关系。方法 选取50例初发或复发的未绝经女性甲亢患者,51例正常对照人群,应用双能X线吸收仪（DXA）测定腰椎1-4、股骨颈、股骨大转子、Ward三角和全股骨的骨密度,电化学发光法测定血浆25(OH)D和PTH,生化法测定血钙、磷、ALP。结果 甲亢组L1、Ward三角骨密度均低于对照组,差异有统计学意义。与对照组相比,甲亢组血钙、血ALP、血浆25(OH)D水平升高,血浆PTH降低,差异均有统计学意义。甲亢组维生素D缺乏17例(34%) , 不足19例(38%) , 充足14例(28%)。对照组维生素D缺乏30例(59%) , 不足18例(35%), 充足3例(6%)。相关分析示,两组血浆25（OH）D与L1、L2、L3、L4、L1-4、股骨颈、股骨大转子、Ward三角、全股骨骨密度均无相关性。Pearson相关分析示,甲亢组血浆25(OH)D与PTH呈负相关（r=-0.378,P<0.01）。结论 未绝经女性甲亢患者L1、Ward三角骨密度降低。未绝经女性甲亢患者血浆25(OH)D升高,可能与高血钙、PTH分泌抑制、高血磷导致1-α-羟化酶活性降低有关。未绝经女性甲亢患者血浆25(OH)D水平与骨密度无直接关系。     

529例成年女性维生素D水平及其影响因素研究

目的 回顾性分析529例成年女性血清25-羟维生素D［25 hydroxy vitamin D,25 ( OH) D］的水平及其影响因素,为骨质疏松症（osteoporosis,OP）及肥胖等疾病的防治提供依据。方法 选取2019年1月-2020年12月在黑龙江中医药大学附属第一医院接受血清25 (OH) D水平检测的成年女性,共计529人,其中19~28岁135人,29~38岁277人,39~48岁54人,49~58岁42人,59~68岁21人。采集受试者清晨空腹静脉血,应用酶联免疫法测定血清25 (OH) D浓度。以血清 25( OH)D＜30 nmol /L 为维生素 D缺乏;血清 25 (OH) D在30～49.9 nmol /L为维生素D不足;血清 25 (OH) D≥50 nmol /L为维生素D充足。统计数据并登记受试者性别、年龄以及采集时间等基本信息,分析血清25 (OH) D水平的影响因素。结果 529例成年女性25 (OH) D平均水平为（19.98±8.58）ng /mL,其中19~28岁组为（18.14±8.02）ng /mL,29~38岁组为（20.44±8.26）ng /mL,39~48岁组为（20.04±10.14）ng /mL,49~58岁组为（20.94±8.55）ng /mL,59-68岁组为（23.64±10.34）ng /mL。19~28岁人群维生素D水平充足的占比最低。不同年龄组相比较（完全随机方差分析one way ANOVA检验）,差异有统计学意义（F=2.88,P＜0.05）。经非参数检验,不同季节间差异有统计学意义（α=0.05）,夏季＞秋季＞春季＞冬季。结论 哈尔滨市成年女性普遍存在维生素D不足,且与年龄及季节具有相关性。     

老年女性晒太阳与其血清25-羟基维生素D关系的调查

目的调查老年女性体内维生素D的含量情况,以及血清25-羟基维生素D[25(OH)D]与晒太阳的关系。方法调查243名老年女性平时晒太阳的情况,年龄61~93岁,平均(81±4)岁,并检测其血清25(OH)D水平,然后分析两者之间的关系。结果老年女性血清25(OH)D正常率仅为7.41%。在243名老年女性中,坚持晒太阳的有157名(64.61%),其25(OH)D含量为(16.81±9.61)ng/ml,不晒太阳的有86名(35.39%),其25(OH)D含量为(13.34±7.78)ng/ml,两者在25(OH)D含量上差异有统计学意义(P0.01)。结论老年女性维生素D正常率极低,而晒太阳是提高老年女性血清25(OH)D含量的重要手段。     

广州地区骨质疏松症患者冬季维生素D水平现状分析

目的调查广州地区冬季骨质疏松症患者体内维生素D(Vit D)水平的状况。方法随机选取2014年12月至2015年2月我院299例年龄≥50岁骨质疏松症患者,采集其清晨空腹静脉血,所有研究对象均采用Cobase 6000型电化学发光仪(瑞士,罗氏诊断)检测血清25-羟维生素D(25(OH)D)和甲状旁腺激素(PTH)水平,日立7180型自动生化分析仪测定钙(Ca)、磷(P)及碱性磷酸酶(ALP)水平。双能X线吸收仪检测腰椎和股骨近端骨密度(BMD),SPSS 16.0软件进行数据分析。结果299例骨质疏松症患者,其中男性患者63例,25(OH)D平均水平为(52.75±17.30)nmol/L,女性患者236例,25(OH)D平均水平(53.97±16.11)nmol/L。其中Vit D正常者仅占3.3%,缺乏者占47.6%,不足者占44.8%,严重不足者占4.3%。这些患者普遍存在着25(OH)D水平不足现象,其中Vit D缺乏和不足所占比例较大,且男女两组的25(OH)D水平无统计学差异。结论本研究显示广州地区冬季骨质疏松症患者25(OH)D不足和缺乏现象较普遍,且无性别差异,补充足量Vit D,需要重视及积极治疗,定期监测25(OH)D水平,为临床骨质疏松症的防治提供一定的数据参考。     

上海地区成人维生素D水平与性别、年龄、季节的关系

目的 了解上海地区成人维生素D水平状况,探讨不同性别、年龄、季节对维生素D水平的影响.方法 将21864例在上海市第六人民医院体检中心进行健康体检者作为研究对象进行回顾性研究,包括男性10566人,女性11298人.结果 21864例研究对象的25(OH)D水平为19.68(15.12,25.48)ng/mL.其中维生...     

骨质疏松症患者血清25-羟维生素D水平的研究

目的：调查了解西安地区骨质疏松症患者体内维生素D 水平的状况。方法随机选取2012年12月－2013年11月我科440例骨质疏松症患者,采集其清晨空腹静脉血,用Cobase 6000型电化学发光仪（瑞士罗氏诊断）检测血中25（OH）D的水平,按照2012年12月－2013年5月为冬春季和2013年6月－2013年11月为夏秋季进行分组,用SPSS13．0软件进行数据分析。结果共调查了440例骨质疏松症患者,其中女性患者数量远大于男性患者,这些患者普遍存在着维生素D水平不足现象,其中维生素D严重缺乏和缺乏所占比例较大,男女两组在年龄和血清25（ OH） D水平上均无统计学差异,而且冬春季患者体内维生素D的水平要低于夏秋季的患者。结论本研究显示西安地区骨质疏松症患者维生素D不足现象比较普遍,男性女性之间无明显差别,而且体内维生素D水平与季节的变化有关,为骨质疏松症的防治提供一定的数据参考。     

中老年人维生素D、骨密度水平与髋部脆性骨折的相关性研究

目的 探讨中老年人维生素D（VitD）、骨密度（bone mineral density, BMD）水平与髋部脆性骨折的相关性。方法 选取2019年1月至2020年8月在岳阳市人民医院接受治疗的50岁以上患者830例,骨折患者135例（骨折组）,非骨折患者695例（非骨折组）。采集所有研究对象的血清,用电化学发光法测定血清25(OH)D水平,应用双能X线吸收仪测定其腰椎及髋部BMD,并在测定骨密度的同时测量患者身高、体重,计算体质量指数（body mass index, BMI）,观察骨折组与非骨折组之间的VitD与BMD差异。结果 ①所有研究对象中25(OH)D严重缺乏者占16.1 %、缺乏者占34.7 %、轻度缺乏者占29.8 %、充足者占19.4 %,男性VitD水平高于女性(P<0.001)。而不同年龄和BMI的VitD水平无统计学差异（P=0.878、0.346）;②所有研究对象的腰椎、股骨颈BMD (T值)平均为–2.64±1.56及–1.43±1.24,不同性别、年龄、体质量指数研究对象的腰椎及股骨颈BMD水平差异有统计学意义(P<0.001);③髋部骨折组平均VitD为(20.26±10.76) ng/mL,非骨折组为(21.18±10.65) ng/mL,两组间无显著差异(P=0.304);④髋部骨折组腰椎、股骨颈T值低于非骨折组(P<0.001)。对骨折影响因素行单因素分析表明VitD、腰椎T值和股骨颈T值、年龄、体质量指数是髋部脆性骨折的危险因素(P＜0.05)。多因素分析表明年龄、体质量指数、股骨颈T值是髋部骨折的独立危险因素（P＜0.05）,而VitD与腰椎T值对骨折的影响呈现一定的风险增大趋势,但无统计学意义。结论 岳阳地区50岁以上人群存在较低的BMD及VitD水平。年龄、体重、体质量指数、股骨颈BMD是中老年人髋部骨折的独立危险因素,VitD不是髋部骨折的独立危险因素。     

The health-related quality of life and cost implications of falls in elderly women

Summary  Fractures and falls are serious cause of morbidity and cost to society. Our results suggest that the main burden to morbidity, measured as impact on health-related quality of life, is due to fear of falling rather than falls or their sequelae, such as fractures. Introduction  Fractures and falls are serious cause of morbidity and cost to society. We investigated the impact on health-related quality of life (HRQoL) associated with falls, fractures and fear of falling and falls and fractures cost. Methods  Three datasets providing longitudinal data on fear of falling, HRQoL and a common set of baseline risk factors for fracture (smoking status, weight and age) were analysed. Multilevel random effects models were used to estimate the long-term impact on HRQoL associated with falls, fractures and fear of falling. Healthcare resource use primary data were collected to estimate falls and fractures cost. Results  Older, low weight and smoking women reported lower HRQoL. The impact on HRQoL of a fracture was at least twice as large as that associated with falls. The largest negative effect on HRQoL was associated with self-reported fear of falling. The cost of falls was ￡1088. Similarly, the cost of falls leading to a fracture was ￡15,133, ￡2,753, ￡1,863, ￡1,331 and ￡3,498 for hip, wrist, arm, vertebral and other fractures, respectively. Discussion  The main burden to morbidity is due to fear of falling. Interventions aimed at reducing fear of falling may produce larger gains in HRQoL.     

广州地区人群中血清25（OH）VitD的水平

目的评价广州正常人血清25（OH）VitD水平,探讨影响血清25（OH）VitD分布的因素。方法自2010年12月至2011年3月在我院体检人群中检查250名正常人（男性组150例,女性组100例,23～79岁）的血清25（OH）VitD水平。结果 250名正常人血清25（OH）VitD水平为17.80±5.35ng/mL,其中男性：18.54±5.37ng/mL;女性：16.71±5.15ng/mL。男性和女性人群血清25（OH）VitD水平差异无统计学意义（P〉0.05）。男性中VitD缺乏的占67.3%,女性中VitD缺乏的占79.0%。年龄与血清25（OH）VitD水平无线性相关性。结论 72.0%的广州正常成年人25（OH）VitD处于缺乏状态。     

Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males

With aging of society, clarification of the relationship between QOL and abnormal posture in the elderly may allow improvement of QOL through any preventive methods and training. However, sagittal balance has not been studied widely and most studies have focused on postmenopausal patients with osteoporosis. In this report, we provide the first evaluation of the simultaneous effects of degenerative changes on radiograph, spinal range of motion (ROM), sagittal balance, and back muscle strength, and examine the influence of these effects on QOL of the middle-aged and elderly male subjects. The subjects were 100 Japanese males who underwent a basic health checkup. Lumbar lateral radiograph, sagittal balance and spinal mobility determined with SpinalMouse^® and back muscle strength were measured. The thoracic/lumbar angle ratio (T/L ratio) was used as an index of sagittal balance. SF-36 physical component summary (PCS) scores showed a significant negative correlation with age (r = −0.377), osteophyte score (r = −0.246) and T/L ratio (r = −0.214), and a significant positive correlation with lumbar lordosis angle (r = 0.271), thoracic ROM (r = 0.282), and back muscle strength (r = 0.549). Multiple regression analysis indicated that thoracic spinal ROM (r = 0.254, p < 0.01) and back muscle strength (r = 0.488, p < 0.0001) were significantly associated with SF-36 PCS (R² = 0.403). In conclusion, QOL of the middle-aged and elderly male subjects was related to sagittal balance, lumbar lordosis angle, spinal ROM, and back muscle strength. Exercise including muscle strength and spinal ROM may be able to influence these primary factors related to QOL. Back muscle strength and thoracic ROM impact on improvement of QOL in the middle-aged and the elderly.     

Estimates of optimal vitamin D status

Vitamin D has captured attention as an important determinant of bone health, but there is no common definition of optimal vitamin D status. Herein, we address the question: What is the optimal circulating level of 25-hydroxyvitamin D [25(OH)D] for the skeleton? The opinions of the authors on the minimum level of serum 25(OH)D that is optimal for fracture prevention varied between 50 and 80 nmol/l. However, for five of the six authors, the minimum desirable 25(OH)D concentration clusters between 70 and 80 nmol/l. The authors recognize that the average older man and woman will need intakes of at least 20 to 25 mcg (800 to 1,000 IU) per day of vitamin D₃ to reach a serum 25(OH)D level of 75 nmol/l. Based on the available evidence, we believe that if older men and women maintain serum levels of 25(OH)D that are higher than the consensus median threshold of 75 nmol/l, they will be at lower risk of fracture.     

上海市绝经后妇女冬季维生素D状况

目的调查上海市绝经后妇女在冬季(12月份)维生素D的状况。方法在社区101例年龄63.7±7.0岁健康绝经后妇女中,检测血清25羟维生素D[25(OH)D]、甲状旁腺激素(PTH),同时检测血钙、磷、碱性磷酸酶、肝肾功能及空腹血糖。所有研究对象均用双能X线吸收仪检测腰椎和股骨近端骨密度(BMD),同时用问卷调查生活方式。结果本研究101例绝经后女性血清25(OH)D平均值为17.09 ng/ml,PTH平均值51.0 pg/ml,维生素D缺乏者占(<20 ng/ml)68%,维生素D不足者(20～29 ng/ml)占了30%,只有2例维生素D充足(>30 ng/ml)占2%。PTH均值在维生素D缺乏组中(53.7 pg/ml)高于维生素D不足组(44.8 pg/ml),有统计学差异(P<0.05);但未发现血清25(OH)D与PTH有线性回归关系。同时未发现血清25(OH)D与血钙、BMD或BMI相关。结论上海市健康绝经后妇女在冬季维生素D普遍不足,维生素D缺乏组的PTH显著高于维生素D不足组,不良的生活方式及低维生素D和钙的摄入应引起重视。     

北京城区老年妇女维生素D营养状况

目的 了解北京城区老年妇女维生素D营养状况.方法 随机选取北京市3个城区17个社区中60岁以上的老年妇女399人,在2008年5轮?旬至7月初采集清晨空腹静脉血分离血清,采用美国DiaSorin公司生产的放射免疫试剂盒测定血25-羟维生素D(25(OH)D)的浓度.结果 在春末夏初,北京市城区老年妇女血清25(OH)D平均水平为(14.4±5.7)ng/ml,维生素D缺乏率(25(OH)D<10 ng/ml)为21.8%,维生素D不足率(10 ng/ml≤25(OH)D<20 ng/ml)为62.4%;从5月到7月,研究对象血清25(OH)D水平逐渐升高.而随着年龄的增大,血清25(OH)D水平有下降的趋势.结论 北京市城区老年妇女维生素D不足的现象比较普遍.     

Vitamin D deficiency in the elderly in Athens,Greece

Vitamin D deficiency characterized by low 25-hydroxyvitamin D [25(OH)D] levels has been found to be prevalent among the elderly in many regions of the world. To investigate the vitamin status in elderly community-living persons in Athens, we measured 25(OH)D and parathyroid hormone (PTH) in elderly persons and young blood donors during the winter and summer. The changes in these parameters in a subgroup of the elderly were studied longitudinally. The blood donors had mean 25(OH)D levels similar in winter and summer and twice as high in winter compared to the elderly. At the end of the winter, about 20% of the elderly had severe vitamin D deficiency, with 25(OH)D below 25 nmol/l, and only 6.5% could be judged as vitamin D sufficient with values above 80 nmol/l. The situation improved during summer, although 64.8% of the elderly continued to have levels below 80 nmol/l. Mean plasma PTH in the elderly in summer was not different from that of blood donors; however, it was doubled during the winter. Regression of PTH on 25(OH)D demonstrated that PTH starts to rise when 25(OH)D falls below approximately 80 nmol/l. We conclude that severe vitamin deficiency associated with secondary hyperparathyroidism is not uncommon in the elderly in Athens during the winter; it subsides during summer, although only one-third of the elderly population attain vitamin D sufficiency during summer. We found that a threshold value of 25(OH)D exists at approximately 80 nmol/l, below which secondary hyperparathyroidism ensues, as described previously.     

Threshold value of serum 25-hydroxyvitamin D concentration in relation to elevated serum parathyroid hormone concentrations in elderly Japanese women

This study was designed to determine the threshold value for 25-hydroxyvitamin D [25(OH)D] concentration in relation to elevated serum parathyroid hormone (PTH) concentrations in elderly Japanese women. The subjects were 582 noninstitutionalized, ambulant women who lived in a community in Japan. Serum 25(OH)D concentrations were determined using the Nichols Advantage chemiluminescent assay, and serum intact PTH concentrations were determined with a two-site immunoradiometric assay. Demographic characteristics, calcium intake, and serum 1,25(OH)₂D levels were also determined. The average age, body mass index (BMI), and calcium intake of the subjects were 74.5 years (SD 4.5), 23.3 kg/m² (SD 3.4), and 579 mg/day (SD 248), respectively. The serum log-transformed intact PTH concentration was significantly predicted by the serum 25(OH)D concentration (r = −0.147, P = 0.0004), but not by age, BMI, the serum log-transformed 1,25(OH)₂D concentration, or the log-transformed calcium intake. Analysis of variance with Dunnett's multiple comparisons showed that mean serum intact PTH concentrations with serum 25(OH)D concentrations less than 30 nmol/l (mean intact PTH = 5.89 pmol/l, P < 0.0001) and in the range 30–39 nmol/l (mean intact PTH = 4.54 pmol/l, P = 0.0067) were significantly higher than mean intact PTH concentrations for serum 25(OH)D concentrations greater than 50 nmol/l (mean intact PTH = 3.65 pmol/l, the baseline level), but the mean serum intact PTH concentration for 25(OH)D concentrations in the range 40–49 nmol/l (mean intact PTH = 3.70 pmol/l, P = 0.9975) was not. We conclude that serum 25(OH)D for ambulant elderly Japanese women should be maintained at 40 nmol/l or higher.     

Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO)

Summary In this observational study of women with an inadequate clinical outcome to osteoporosis therapy, those with a fracture at baseline were more likely to sustain an incident fracture and have a worse health-related quality of life than those without prior fracture. Introduction The Observational Study of Severe Osteoporosis (OSSO) was designed to assess the fracture incidence and health-related quality of life (HRQoL) in women with an inadequate clinical outcome to osteoporosis therapy. Methods Post-menopausal women (N = 1,885) with established osteoporosis and an inadequate clinical response to osteoporosis drug therapy defined as: a) a fragility fracture despite therapy for one year (index fracture, N = 988), or b) discontinued drug therapy due to adverse effects and/or non-compliance (N = 897), were assessed during one year for HRQoL using the EQ-5D and the QUALEFFO questionnaires. Results One hundred and sixty-six (8.8%) women had a total of 209 incident fractures (1,139 fractures/10,000 women-years). Women with an index fracture were more likely to sustain an incident fracture than those without prior fractures (hazard ratio 1.91; 95% CI: 1.37–2.66; p < 0.001). Co-morbidities or antidepressant use at baseline also increased the risk of incident fracture. Median total EQ-5D Health State Values and QUALEFFO scores were worse in women with an incident fracture regardless of index fracture status. The worst scores were reported in the EQ-5D sub-domains of self-care, usual activities and pain/discomfort. Conclusions Women with an inadequate response to osteoporosis therapy had a high rate of incident fracture which had an adverse impact on HRQoL.