Prevalence of vitamin D inadequacy in osteoporotic hip fracture patients in London

ABSTRACT

Background: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age,?or below the normal range.

Objectives: To investigate the prevalence of vitamin D inadequacy in an elderly population with hip fractures from London (UK) and compare levels with data previously presented from Glasgow (UK).

Research design and methods: A retrospective patient audit was carried out over a 17‐month period (September 2003–January 2005). Patient records were searched for hip fracture admissions and cross matched with vitamin D analysis carried out within 3 days of the hip fracture admission. The resulting records were hand searched to exclude patients with a hip fracture resulting from high impact/trauma.

Results: There were data for 103 hip fracture patients, 79.6% of the patients were women (n = 82). The mean age at the time of fracture was 73.4 years, 100% were aged 60 years or over and 41% were aged 75 years or over. Around 20% of the patients were receiving supplementation with calcium and/or vitamin D and were not excluded from the analysis. The mean vitamin D level was 32.1?nmol/L (12.9?ng/mL), SD = 19.4 (7.8), however, it is likely that the true mean is lower since in approximately 15% of cases vitamin D levels were reported as < 12.5?nmol/L, but were transcribed at 12.5?nmol/L in order to allow a numerical value to be calculated. Ninety-nine per cent of patients had a vitamin D level < 80?nmol/L, 94.2% < 70?nmol/L and 81.6% < 50?nmol/L.

There were no significant differences by patient age or sex, however, there were significant seasonal differences in vitamin D. In the year from September 2003 to August 2004, 82.8% of summer admissions had vitamin D levels < 70?nmol/L compared with 98.0% in winter (?p = 0.04). Mean vitamin D levels in the 30 patients with parathyroid hormone (PTH) levels above the reference range were significantly lower than levels in the 71 patients within the range: mean 19.9?nmol/L, SD = 16.2 versus mean 37.5?nmol/L, SD = 18.5 (?p < 0.0001). Furthermore, 50% of the patients with PTH levels above the reference range had vitamin D levels < 12.5?nmol/L, reflecting extremely low levels of vitamin D.

Conclusions: This study confirms almost universal vitamin D inadequacy among 103 patients admitted to hospital with hip fracture in London, although the prevalence of inadequacy is slightly lower than that seen in a similar study carried out in Glasgow.     

Prevalence of vitamin D inadequacy in Scottish adults with non-vertebral fragility fractures

ABSTRACT

Background: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age, or below the normal range.

Objectives: To investigate the prevalence of vitamin D inadequacy in an elderly population presenting to the South Glasgow Fracture Liaison Service with non-vertebral fragility fractures in order to assess the extent of the problem.

Research design and methods: The retrospective arm of this study used data from an established database to identify patients aged over 50 years admitted to South Glasgow University Hospitals over the previous 4 years with hip fracture. The prospective arm identified the first 50 patients aged over 50 presenting with a clinical non-vertebral fragility fracture with osteoporosis as measured by axial spine and/or hip DEXA (T‐score < –2.5) after November 2004.

Results: In the retrospective arm, 626 patients were identified from the database: mean age 80.5 years; 94% were aged over 60 and 74% were aged over 75. Data analysis was limited to 548 patients aged over 60 years with vitamin D recordings and not receiving supplementation with calcium and vitamin D. The mean vitamin D level was 24.7?nmol/L (9.9?ng/ml) SD = 17, however, it is likely that the true mean is lower since in approximately 25% of cases vitamin D levels were reported as < 15?nmol/L (effectively unrecordable). These were transcribed as 15?nmol/L in order to permit a numerical value to be calculated. In the absence of an agreement on what should constitute a diagnostic serum level of vitamin D inadequacy, a number of thresholds were considered – 97.8% had vitamin D levels below 70?nmol/L and 91.6% had vitamin D levels below 50?nmol/L. There were no significant differences by patient sex, age or season of presentation.

The mean age of patients in the prospective arm was 65.8 years (range 50.6–83.8), 72% were aged over 60 and 16% were aged over 75. The mean vitamin D level was 44.1?nmol/L (18.4?ng/ml) SD = 25.3; 82% had vitamin D levels below 70?nmol/L and 72% had vitamin D levels below 50?nmol/L. Although numbers were too small to justify extensive subgroup analyses, the mean vitamin D level in the 13 patients with hip fracture (34.5?nmol/L) was lower than in the 37 with non-hip fractures (48.2?nmol/L).

Conclusions: This study confirms almost universal vitamin D inadequacy among 548 elderly patients admitted to hospital with hip fracture, regardless of whether a threshold of 50?nmol/L or 70?nmol/L was used. However, among a prospective subset of 50 patients with clinical fragility fractures, especially those with non-hip fractures, the prevalence of inadequacy was substantially lower. It may be that vitamin D represents a correctable risk factor for fragility fracture in the elderly, possibly specifically for the hip.     

Prevalence of vitamin D inadequacy in patients attending a metabolic bone clinic in Medway

BACKGROUND: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture have low levels of serum vitamin D. OBJECTIVES: To investigate the prevalence of vitamin D inadequacy in Medway, Kent in patients attending a metabolic bone clinic and in patients with fragility fractures and to compare levels with data previously presented from Glasgow. RESEARCH DESIGN AND METHODS: Retrospective patient records audit of patients attending the metabolic bone clinic from 1998 to 2005. RESULTS: There were data for 870 patients, 77.5% of the patients were women (n = 674) and 48.2% (n = 420) of patients had a fragility fracture. The mean age was 61.6 years (SD = 14.12), 56.4% were aged 60 years or over and 17.7% were aged 75 years or over. The mean vitamin D level was 47.7 nmol/L (19.1 ng/mL), SD = 25.8 (10.3). Of the patients 88.7% had a vitamin D level < 80 nmol/L, 81.4% < 70 nmol/L and 59.1% < 50 nmol/L.Of the 420 patients with fragility fracture, 78.1% were women and the mean age was 66.6 years (SD = 12.22). The mean vitamin D level was 45.3 nmol/L (18.1 ng/mL), SD = 25.8 (10.3). In patients not receiving supplementation (n = 222) the mean vitamin D level was 40.5 nmol/L (16.2 ng/mL), SD = 20.9 (8.4) and 95.9% of patients had a vitamin D level < 80 nmol/L, 89.6% < 70 nmol/L and 71.2% < 50 nmol/L.In order to compare data from Medway with previously published data from Glasgow, a subset of 198 patients with fragility fracture, aged over 50 years, attending the metabolic bone clinic and not receiving supplementation with calcium and/or vitamin D was analysed. There were 76.6% women and the mean age was 68.6 years (SD = 9.1). The mean vitamin D level was 40.0 nmol/L (16.0 ng/mL), SD = 21.5 (8.6). Of these patients 96.4% had a vitamin D level < 80 nmol/L, 89.7% < 70 nmol/L and 73.2% < 50 nmol/L.Data on the month of vitamin D assessment were available for 499 patients. The mean vitamin D in the summer (April-September) months (n = 217) was significantly higher than in the winter (October-March) months (n = 281): 53.2 nmol/L (SD = 29.4) versus 47.3 (SD = 24.9), p = 0.02. Parathyroid hormone (PTH) levels were available for 289 patients. Mean vitamin D levels in the 47 patients with PTH levels above the reference range were significantly lower than vitamin D levels in the 238 patients within the reference range for PTH: mean 31.1 nmol/L, SD = 21.1 versus mean 46.5 nmol/L, SD = 24.8 (p = 0.000092). Four patients had PTH levels below the reference range. CONCLUSIONS: The prevalence of vitamin D inadequacy is high in patients attending a metabolic bone clinic, in particular in those patients with fragility fractures. The prevalence of inadequacy is comparable with that seen in Glasgow.     

Prevalence of vitamin D inadequacy in European postmenopausal women

ABSTRACT

Objective: Inadequate vitamin D level is associated with secondary hyperparathyroidism and increased bone turnover and bone loss, which in turn increases fracture risk. The objective of this study is to assess the prevalence of inadequate serum vitamin D levels in postmenopausal European women. There are no clear international agreements on what constitutes a level of vitamin D inadequacy, but recent publications suggest that the circulating level of vitamin D should be over 80?nmol/L or at least between 50 and 80?nmol/L.

Material and methods: Assessment of 25-hydroxyvitamin D [25(OH)D] was performed in 8532 European postmenopausal women with osteoporosis or osteopenia. European countries included France, Belgium, Denmark, Italy, Poland, Hungary, United Kingdom, Spain and Germany. Two cut-offs of 25(OH)D inadequacy were fixed : < 80?nmol/L and < 50?nmol/L.

Results: Mean (SD) age of the patients was 74.2 (7.1) years, body mass index was 25.7 (4.1)?kg/m². Level of 25(OH)D was 61.0 (27.2)?nmol/L. There was a highly significant difference of 25(OH)D level across European countries (?p < 0.0001). The lowest level of 25(OH)D was found in France [51.5 (26.1)?nmol/L] and the highest in Spain [85.2 (33.3)?nmol/L]. In the whole study population, the prevalence of 25(OH)D inadequacy was 79.6% and 32.1% when considering cut-offs of 80 and 50?nmol/L, respectively and when considering patients aged less than 65 years, the prevalence reached 86% (cut-off of 80?nmol/L) and 45% (cut-off of 50?nmol/L).

Conclusion: This study indicates a high prevalence of vitamin D [25(OH)D] inadequacy in European postmeno­pausal women. The prevalence could be even higher in some particular countries. A greater awareness of the importance of vitamin D inadequacy is needed to address this public health problem.     

Prevalence of vitamin D inadequacy in a minimal trauma fracture population

ABSTRACT

Objective: The purpose of this analysis was to report the prevalence of vitamin D inadequacy in a population of adults with minimal trauma fractures.

Research Design and Methods: 82 adults (ages 52–97 with 63% age 80+) consecutively hospitalized with hip and extremity fractures between August 2001 and January 2002 were recruited from two St. Paul, MN hospitals. Patients came from independent living and assisted living facilities. Demographics, medical history and vitamin D supplementation were obtained by the medical record and self-report. Blood specimens were collected during hospitalization within 48 hours of admission. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were assessed using Diasorin 25-hydroxyvitamin D radioimmunoassay kit (RIA) at Mayo Clinic, Rochester, MN. Results were available for 78 patients and are included in the current analysis.

Results: Patients were 99% Caucasian, 63% ≥ 80 years and 78% female. 97% were admitted due to hip fracture. On admission, 50% reported using at least 400?IU per day of vitamin D through supplements (including multivitamins) and 13% of all patients were taking osteoporosis medication (3 estrogen, 5 alendronate, 1 etidronate, 1 raloxifene). The mean 25(OH)D concentration was 14.2 (SD 6.6) with a range of 5–39?ng/mL (8–38?ng/mL wintertime vales in Rochester, MN). All but two of the 78 patients (97.4%) had 25(OH)D concentrations < 30?ng/mL and the majority (81%) of the patients had 25(OH)D concentrations < 20?ng/mL, including 21% < 9?ng/mL. Mean 25(OH)D concentrations were not substantially different by gender, age, or osteoporosis medication use. Patients who reported vitamin D supplementation ≥ 400?IU/day had significantly greater mean 25(OH)D concentrations, albeit suboptimal, compared to those who did not (16.4 vs. 13.7?ng/mL; p = 0.002).

Conclusions: Nearly all patients in this study hospitalized for fracture had vitamin D inadequacy. Significant opportunity exists to ensure adequate and persistent vitamin D intake in a high risk fracture patient population.     

葡萄糖酸钙联合维生素D和骨肽辅助治疗老年性骨折的临床疗效观察

目的探讨葡萄糖酸钙联合维生素D和骨肽辅助治疗老年性骨折的临床效果。方法选择本院2007年2月～2012年7月收治的100例老年性骨折患者为研究对象,随机分为两组。对照组给予常规药物治疗,治疗组在常规治疗的基础上给予葡萄糖酸钙联合维生素D和骨肽辅助治疗。治疗后,比较两组有效率、骨密度以及住院时间、骨折愈合时间等。结果治疗组患者有效率、骨密度、住院时间以及骨折愈合时间均优于对照组,差异有统计学意义（P〈0.05）。治疗组方案安全性较好,治疗期间未见与葡萄糖酸钙、骨肽等相关的严重不良反应。结论葡萄糖酸钙联合维生素D和骨肽辅助治疗老年性骨折能加速患者康复,提高骨密度,具有较好的临床安全性,值得推广应用。     

Full length parathyroid hormone,PTH(1-84), for the treatment of severe osteoporosis in postmenopausal women

ABSTRACT

Objective: To review and analyse the evidence supporting the use of full length parathyroid hormone, PTH(1-84), in the treatment of osteoporosis based on a search of several literature sources; articles selected for review were published between 1990 and 2008.

Background: PTH(1-84) is approved for the treatment of osteoporosis in postmenopausal women at high risk of fracture in Europe. It was well tolerated in clinical trials and demonstrated bone building properties and fracture prevention particularly for the lumbar spine in the treatment of postmenopausal women.

Results: The TOP clinical trial showed that PTH(1-84) treatment for 18 months resulted in a 61% reduction (p = 0.001) in new vertebral fracture incidence when compared with placebo and reduced the risk of a first vertebral fracture by 68% (p = 0.006) in women without a prevalent fracture at baseline. PTH(1-84) increased bone mineral density (BMD) at vertebral and non-vertebral sites the lumbar spine BMD increasing regardless of T-score, age, prior osteoporosis therapy or number of years post-menopause. The PaTH study showed that treatment with PTH(1-84) for 12 months increased BMD at the trabecular spine and hip. Lumbar spine BMD gains were largest with sequential administration of PTH(1-84) followed by alendronate but were smaller with concurrent administration involving anabolic and antiresorptive agents. Lumbar spine BMD increases were also seen in trials involving PTH with raloxifene and PTH in combination with hormone replacement therapy.

Conclusions: PTH(1-84) has demonstrated effective bone building qualities and extends the therapeutic options available to osteoporotic women. The use of PTH(1-84) followed by sequential administration of an antiresorptive has proved effective at increasing trabecular BMD and points towards new treatment regimens offering improvements in BMD and fracture prevention.     

甲状旁腺素研究进展

甲状旁腺素是治疗骨质疏松症的重要药物,具有刺激骨骼生长,加强骨组织微结构,降低骨脆性的作用。但是,甲状旁腺素属于肽类药物需注射给药且价格昂贵,发展新型非肽类骨质疏松症治疗药物成为当前研究热点。文章综述了甲状旁腺素的生物学活性、结构特征及其构效关系,并对甲状旁腺素与受体的结合机制进行了总结,为开发新型非肽类抗骨质疏松症药物提供了理论依据。     

Phase IV randomized preference study in patients eligible for calcium and vitamin D supplementation

Introduction/objectives: Preference for supplement formulation helps determine an individual’s adherence to long-term medication and can improve clinical benefit for chronic illnesses such as osteoporosis. This study compared the preference, acceptability and tolerability of a reformulation of Calcichew D3¹ 500?mg/400?IU and Calcichew D3 500?mg/800?IU (Takeda UK Ltd, Wobrun Green, UK) with Adcal-D3² 500?mg/400?IU (ProStrakan Ltd, Galashiels, UK) and Kalcipos-D 500?mg/800?IU (Meda Pharmaceuticals Ltd, Bishop's Stortford, UK), respectively.

Method: This phase IV, randomized, open-label, two-period, cross-over study was conducted at nine sites in the UK and Germany. Eligible subjects (≥65 years requiring calcium/vitamin D supplementation for prevention/treatment of deficiencies, or ≥18 years requiring supplementation as an adjunct to osteoporosis treatment) were randomly assigned to one of two 2 week treatment sequences – Group 1: Calcichew D3 500/400 then Adcal-D3 500/400 (or vice versa), or Group 2: Calcichew D3 500/800 then Kalcipos-D 500/800 (or vice versa). After each treatment period, patients rated the treatment for acceptability using 100?mm visual analogue scales. After the second treatment period, patients indicated their treatment preference. The primary endpoint, the percentage of patients with a preference for each treatment, was analyzed with a logistic regression model.

Results: Two hundred and seventy-six patients were randomly assigned by treatment sequence, 138 to each group. Preference questionnaires among patients who preferred Calcichew or comparator revealed the odds for patients preferring Calcichew 500/400 (77.6%) over Adcal-D3 was 3.46 ([95% CI 2.24, 5.36], p?<?0.001) in Group 1, and Calcichew D3 500/800 (63.2%) over Kalcipos-D was 1.72 ([1.19, 2.47], p?=?0.004) in Group 2. Adverse events were mostly gastrointestinal and were comparable between groups. The new formulation of Calcichew D3 is acceptable and consistent with its known tolerability profile.

Conclusions: In this short-term 30?day study, patients preferred Calcichew D3 500/400 and Calcichew D3 500/800 over respective comparators. A trend towards better compliance with Calcichew D3 preference observed in Group 1 warrants a longer term study to identify treatment compliance.

Trial registration: Clinicaltrials.gov: NCT02457247.     

Prevalence of vitamin D inadequacy in osteoporotic hip fracture patients in London

BACKGROUND: It is well established that vitamin D levels are suboptimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age, or below the normal range. OBJECTIVES: To investigate the prevalence of vitamin D inadequacy in an elderly population with hip fractures from London (UK) and compare levels with data previously presented from Glasgow (UK). RESEARCH DESIGN AND METHODS: A retrospective patient audit was carried out over a 17-month period (September 2003-January 2005). Patient records were searched for hip fracture admissions and cross matched with vitamin D analysis carried out within 3 days of the hip fracture admission. The resulting records were hand searched to exclude patients with a hip fracture resulting from high impact/trauma. RESULTS: There were data for 103 hip fracture patients, 79.6% of the patients were women (n = 82). The mean age at the time of fracture was 73.4 years, 100% were aged 60 years or over and 41% were aged 75 years or over. Around 20% of the patients were receiving supplementation with calcium and/or vitamin D and were not excluded from the analysis. The mean vitamin D level was 32.1 nmol/L (12.9 ng/mL), SD = 19.4 (7.8), however, it is likely that the true mean is lower since in approximately 15% of cases vitamin D levels were reported as < 12.5 nmol/L, but were transcribed at 12.5 nmol/L in order to allow a numerical value to be calculated. Ninety-nine per cent of patients had a vitamin D level < 80 nmol/L, 94.2% < 70 nmol/L and 81.6% < 50 nmol/L. There were no significant differences by patient age or sex, however, there were significant seasonal differences in vitamin D. In the year from September 2003 to August 2004, 82.8% of summer admissions had vitamin D levels < 70 nmol/L compared with 98.0% in winter (p = 0.04). Mean vitamin D levels in the 30 patients with parathyroid hormone (PTH) levels above the reference range were significantly lower than levels in the 71 patients within the range: mean 19.9 nmol/L, SD = 16.2 versus mean 37.5 nmol/L, SD = 18.5 (p < 0.0001). Furthermore, 50% of the patients with PTH levels above the reference range had vitamin D levels < 12.5 nmol/L, reflecting extremely low levels of vitamin D. CONCLUSIONS: This study confirms almost universal vitamin D inadequacy among 103 patients admitted to hospital with hip fracture in London, although the prevalence of inadequacy is slightly lower than that seen in a similar study carried out in Glasgow.     

Prevalence of vitamin D inadequacy in a minimal trauma fracture population

OBJECTIVE: The purpose of this analysis was to report the prevalence of vitamin D inadequacy in a population of adults with minimal trauma fractures. RESEARCH DESIGN AND METHODS: 82 adults (ages 52-97 with 63% age 80+) consecutively hospitalized with hip and extremity fractures between August 2001 and January 2002 were recruited from two St. Paul, MN hospitals. Patients came from independent living and assisted living facilities. Demographics, medical history and vitamin D supplementation were obtained by the medical record and self-report. Blood specimens were collected during hospitalization within 48 hours of admission. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were assessed using Diasorin 25-hydroxyvitamin D radioimmunoassay kit (RIA) at Mayo Clinic, Rochester, MN. Results were available for 78 patients and are included in the current analysis. RESULTS: Patients were 99% Caucasian, 63% >/=80 years and 78% female. 97% were admitted due to hip fracture. On admission, 50% reported using at least 400 IU per day of vitamin D through supplements (including multivitamins) and 13% of all patients were taking osteoporosis medication (3 estrogen, 5 alendronate, 1 etidronate, 1 raloxifene). The mean 25(OH)D concentration was 14.2 (SD 6.6) with a range of 5-39 ng/mL (8-38 ng/mL wintertime vales in Rochester, MN). All but two of the 78 patients (97.4%) had 25(OH)D concentrations < 30 ng/mL and the majority (81%) of the patients had 25(OH)D concentrations < 20 ng/mL, including 21% < 9 ng/mL. Mean 25(OH)D concentrations were not substantially different by gender, age, or osteoporosis medication use. Patients who reported vitamin D supplementation >/= 400 IU/day had significantly greater mean 25(OH)D concentrations, albeit suboptimal, compared to those who did not (16.4 vs. 13.7 ng/mL; p = 0.002). CONCLUSIONS: Nearly all patients in this study hospitalized for fracture had vitamin D inadequacy. Significant opportunity exists to ensure adequate and persistent vitamin D intake in a high risk fracture patient population.     

骨密度检查对维生素D缺乏性佝偻病的诊断价值

目的分析超声骨密度检查对维生素D缺乏性佝偻病的诊断价值。方法选取2016年1月-2018年1月于铁岭县中心医院儿科健康体检的0~3岁小儿300例为研究对象,所有患儿均采取超声骨密度和血清25羟维生素D检查,对比并分析检查结果。结果超声骨密度组总异常率高于血清25羟维生素D组,差异有统计学意义(P<0.05)。随着年龄的递增,骨密度结果异常率随之降低,早产儿的骨密度结果异常率高于足月儿,差异均有统计学意义(P<0.05)。结论超声骨密度检查可有效诊断维生素D缺乏性佝偻病,值得推广。     

降钙素、睾酮及甲状旁腺激素与骨质疏松患者骨密度的关系

目的：探讨降钙素、睾酮及甲状旁腺激素与骨质疏松患者骨密度的关系。方法选择确诊老年骨质疏松症患者40例为观察组,选取正常体检者40例为对照组,测定两组不同部位骨密度,并分析降钙素、睾酮及甲状旁腺激素水平的变化。结果观察组第四腰椎、股骨大转子及前臂远端骨密度均显著低于对照组（P＜0.05）。观察组降钙素、睾酮水平均低于对照组（P＜0.05）,甲状旁腺激素水平高于对照组（P＜0.05）。结论老年骨质疏松症患者降钙素、睾酮水平降低,甲状旁腺激素升高,可作为临床诊断的指标之一。     

New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion

ABSTRACT

Background: Adequate vitamin D and calcium nutrition play a critical role in the maintenance of musculoskeletal health and are considered the first step in osteoporosis treatment.

Roundtable discussion: In February 2008 Merck Sharp & Dohme sponsored a 2-day, evidence-based expert panel on the benefits of vitamin D for the patient with osteoporosis and the role of vitamin D in combination with antiresorptive therapy for the management of osteo­porosis. One of the primary objectives of the meeting was to review new data on the optimal serum 25-hydroxy­vitamin D [25(OH)D]levels. The symposium was attended by 29 researchers and clinicians from Europe and the Middle East. The discussion focused on optimizing vitamin D and calcium nutrition and reducing falls and fractures in osteoporotic patients.

Conclusions: Current evidence and expert opinion suggests that optimal serum 25(OH)Dconcentrations should be at least 50?nmol/L (20?ng/mL) in all individuals. This implies a population mean close to 75?nmol/L (30?ng/mL). In order to achieve this level, vitamin D intake of at least 20?µg daily is required. There is a wider thera­peutic window for vitamin D than previously believed, and doses of 800?IU per day, regardless of sun exposure, season or additional multivitamin use, appear to present little risk of toxicity. Apart from fracture and fall preven­tion, optimization of vitamin D status may also have additional general health benefits. Based on newly emerging data regarding calcium supplementation, and recommendations for increased vitamin D intake, the current recommendations for calcium intake in postmenopausal women may be unnecessarily high. In addition to vitamin D and calcium, treatment of patients with osteo­porosis at high risk of fractures should also include pharmacologic agents with proven vertebral and non-vertebral fracture efficacy.     

超重或肥胖儿童维生素D水平与静息代谢率的相关性分析

目的 探讨超重或肥胖儿童维生素D水平与静息代谢率的相关性。方法 选取2017年6月至2018年8月安徽医科大学第一附属医院儿科门诊或病房7～14岁超重或肥胖儿童67例为研究对象（超重或肥胖组）,并选取83例同期体质量正常的健康体检儿童为对照组,检测两组研究对象血清维生素D水平及静息代谢率,并比较两组维生素D水平、静息代谢率及单位体质量静息代谢率的差异,分析维生素D水平与静息代谢率、单位体质量静息代谢率之间的相关性。结果 超重或肥胖组儿童维生素D水平低于对照组,单位体质量静息代谢率较对照组低,差异均有统计学意义（P<0.05）。对照组儿童单位体质量静息代谢率与维生素D水平正相关（r=0.290,P<0.05）;超重或肥胖组儿童单位体质量静息代谢率与维生素D水平无相关性。结论 血清维生素D缺乏可能在超重或肥胖儿童单位体质量静息代谢率下降中不发挥主要作用。     

Comment and Reply on:International Society for Medical Publication Professionals (ISMPP) position statement: the role of the professional medical writer

Abstract

Objective:

To determine the safety and efficacy of full-length parathyroid hormone, PTH(1–84), treatment for up to 36 months by evaluating bone mineral density (BMD) changes, bone histomorphometric indices, and clinical fracture incidence in postmenopausal women with osteoporosis.     

子宫内膜异位症病人卵巢储备功能与维生素 D的关系研究

目的 探究子宫内膜异位症病人血清维生素D(VD)及抗苗勒管激素(AMH)水平变化及其相关性.方法 选取2019年9—11月苏州市立医院收治的卵巢良性肿瘤病人109例,入院时测定血清VD及AMH水平,根据术后病理,其中49例卵巢子宫内膜异位症为巧囊组,其他类型卵巢肿瘤60例为对照组,对比两组VD及AMH水平并分析其相关性.使用随机数字表法将巧囊组分为VD组和安慰剂组,分别于VD及安慰剂治疗前和治疗3个月后检测两组血清VD和AMH水平.结果 巧囊组病人AMH水平(3.39±0.34)μg/L低于对照组(3.61±0.43)μg/L,巧囊组病人和对照组相比,VD水平偏低(12.90±1.14)μg/L比(13.74±1.39)μg/L(P<0.05).巧囊组病人血清VD与AMH存在弱的正相关性(Pearson's r=0.345,P=0.015);而对照组病人两者无相关性(Pearson's r=0.087,P=0.646).VD组和安慰剂组术后3 d血清AMH下降比率(％)分别为19.43和20.47.VD组在治疗3月后血清AMH值明显高于安慰剂组(P=0.029).VD组和安慰剂组术后3月血清AMH恢复比率分别为30.26％和23.98％.结论 卵巢子宫内膜异位症相对其他良性卵巢肿瘤病人,血清VD及AMH水平较低,且两者存在弱相关性.卵巢子宫内膜异位症术后使用VD治疗,AMH恢复较快.VD有潜力作为一种辅助疗法改善卵巢子宫内膜异位症卵巢储备功能.