PREVALENCE AND RISK FACTORS OF VITAMIN D INADEQUACY AMONG THAI ELDERLY PATIENTS WITH OSTEOPOROTIC HIP FRACTURE

  • Tanawat Amphansap Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
  • Pipat Wongthanakitcharoen Department of Orthopaedics, Bangkok Ratchasima Hospital, Nakhonratchasima, Thailand
  • Nitirat Stitkitti Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
  • Worawut Chaiyosburana Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
  • Atiporn Therdyothin Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
Keywords: Vitamin D inadequacy, Vitamin D deficiency, Risk factor, Fragility hip fracture

Abstract

Background: Vitamin D deficiency directly impacts bone biology, eventually resulting in elevated risk of fragility fracture. Despite its global abundance, data concerning its prevalence and risk factors among Thai patients with osteoporotic hip fractures remains lacking.

Objectives: This study aimed to evaluate the average level of serum vitamin D, prevalence of hypovitaminosis D and its risk factor among Thai elderly patients with fragility hip fractures.

Methods: A cross-sectional study was conducted among Thai patients with fragility hip fractures aged 60 years or older in a single center from April 2016-April 2020. The patients were divided according to serum 25-hydroxy vitamin D (25-(OH)D) levels. Demographic data were compared to identify risk factors of vitamin D inadequacy.

Results: Of 258 patients, 74.81% were females with mean age of 78.76 years. The average serum 25(OH)D level was 19.64 ng/mL. Prevalences of vitamin D inadequacy, vitamin D insufficiency and vitamin D deficiency were 86.05, 28.69 and 57.36%, respectively. When compared with the vitamin D sufficiency group, the vitamin D inadequacy group had a history of frequent falls, higher body mass index (BMI) as well as high parathyroid hormone (PTH) levels.

 Risk factors associated with vitamin D inadequacy were BMI >23 kg/m2 (AOR= 4.67, 95%CI=1.24-17.73), and two or more falls within a year (AOR= 3.96, 95%CI=1.38-11.33). Moreover, risk factors associated with vitamin D deficiency were being female (AOR= 2.87, 95%CI=1.06-7.78), BMI >23 kg/m (AOR=7.20, 95%CI =1.67-31.02), two or more falls within one year (AOR=7.32, 95%CI =2.17-24.69) and elevated PTH level (AOR= 3.38, 95%CI=1.17-0.74).

Conclusion: Most elderly patients with fragility hip fractures had hypovitaminosis D. Risk factors included high BMI, frequent falls for vitamin D inadequacy, being female and high PTH levels for vitamin D deficiency. Serum 25(OH)D assessment and appropriate supplement are recommended, especially for patients with fragility hip fractures and aforementioned risk factors.

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References

Songpatanasilp T, Sritara C, Kittisomprayoonkul W, Chaiumnuay S, Nimitphong H, Charatcharoenwitthaya N, et al. Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis. Osteoporos Sarcopenia 2016; 2: 191-207. DOI: https://doi.org/10.1016/j.afos.2016.10.002

Schattner A. The burden of hip fractures—why aren’t we better at prevention? QJM: An Int J Med 2018; 111: 765-7. DOI: https://doi.org/10.1093/qjmed/hcx216

Wongtriratanachai P, Luevitoonvechkij S, Songpatanasilp T, Sribunditkul S, Leerapun T, Phadungkiat S, et al. Increasing incidence of hip fracture in Chiang Mai, Thailand. J Clin Densitom 2013; 16: 347-52. DOI: https://doi.org/10.1016/j.jocd.2012.07.002

Chaysri R, Leerapun T, Klunklin K, Chiewchantanakit S, Luevitoonvechkij S, Rojanasthien S. Factors related to mortality after osteoporotic hip fracture treatment at Chiang Mai University Hospital, Thailand, during 2006 and 2007. J Med Assoc Thai 2015; 98: 59-64.

Wyskida M, Wieczorowska-Tobis K, Chudek J. Prevalence and factors promoting the occurrence of vitamin D deficiency in the elderly. Postepy Hig Med Dosw 2017; 71: 198-204. DOI: https://doi.org/10.5604/01.3001.0010.3804

Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001; 22: 477-501. DOI: https://doi.org/10.1210/edrv.22.4.0437

Phusunti S, Suthutvoravut W, Unnanuntana A, Chotiyarnwong P. The prevalence of hypovitaminosis D in patients with fragility hip fracture at a single institution in Thailand. J Med Assoc Thai 2016; 99: 1233-8.

Ramason R, Selvaganapathi N, Ismail NH, Wong WC, Rajamoney GN, Chong MS. Prevalence of vitamin D deficiency in patients with hip fracture seen in an orthogeriatric service in sunny singapore. Geriatr Orthop Surg Rehabil 2014; 5: 82-6. DOI: https://doi.org/10.1177/2151458514528952

Niikura T, Oe K, Sakai Y, Iwakura T, Fukui T, Nishimoto H, et al. Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population. J Orthop Surg (Hong Kong) 2019; 27: 2309499019877517. DOI: https://doi.org/10.1177/2309499019877517

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-30. DOI: https://doi.org/10.1210/jc.2011-0385

Halfon M, Phan O, Teta D. Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty. Biomed Res Int 2015; 2015: 953241. DOI: https://doi.org/10.1155/2015/953241

Soontrapa S, Soontrapa S, Bunyaratavej N, Rojanasthien S, Kittimanon N, Lektrakul S. Vitamin D status of Thai premenopausal women. J Med Assoc Thai 2009; 92 (Suppl5): S17-20.

Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B. Regional variation and determinants of vitamin D status in sunshine-abundant Thailand. BMC Public Health 2011; 11: 853. DOI: https://doi.org/10.1186/1471-2458-11-853

Gallagher JC. Vitamin D and aging. Endocrinol Metab Clin North Am 2013; 42: 319-32. DOI: https://doi.org/10.1016/j.ecl.2013.02.004

Nimitphong H, Chailurkit LO, Chanprasertyothin S, Sritara P, Ongphiphadhanakul B. The association of vitamin D status and fasting glucose according to body fat mass in young healthy Thais. BMC Endocr Disord 2013; 13: 60. DOI: https://doi.org/10.1186/1472-6823-13-60

Unnanuntana A CP. The Use of Stratified Vitamin D2 Supplementation regimen for restoring and maintaining sufficient vitamin D level. J Med Assoc Thai 2017; 100: 1095.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000; 72: 690-3. DOI: https://doi.org/10.1093/ajcn/72.3.690

Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 2002; 75: 611-5. DOI: https://doi.org/10.1093/ajcn/75.4.611

Mowé M, Haug E, Bøhmer T. Low serum calcidiol concentration in older adults with reduced muscular function. J Am Geriatr Soc 1999; 47: 220-6. DOI: https://doi.org/10.1111/j.1532-5415.1999.tb04581.x

Bischoff-Ferrari HA, Borchers M, Gudat F, Dürmüller U, Stähelin HB, Dick W. Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res 2004; 19: 265-9. DOI: https://doi.org/10.1359/jbmr.2004.19.2.265

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 2000; 66: 419-24. DOI: https://doi.org/10.1007/s002230010085

Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692. DOI: https://doi.org/10.1136/bmj.b3692

Goltzman D. Physiology of parathyroid hormone. Endocrinol Metab Clin North Am 2018; 47: 743-58. DOI: https://doi.org/10.1016/j.ecl.2018.07.003

Weaver CM, Bischoff-Ferrari HA, Shanahan CJ. Cost-benefit analysis of calcium and vitamin D supplements. Arch Osteoporos 2019; 14: 50. DOI: https://doi.org/10.1007/s11657-019-0589-y

Published
2022-03-17
How to Cite
1.
Amphansap T, Wongthanakitcharoen P, Stitkitti N, Chaiyosburana W, Therdyothin A. PREVALENCE AND RISK FACTORS OF VITAMIN D INADEQUACY AMONG THAI ELDERLY PATIENTS WITH OSTEOPOROTIC HIP FRACTURE. J Southeast Asian Med Res [Internet]. 2022Mar.17 [cited 2022Aug.9];60:e0110. Available from: https://www.jseamed.org/index.php/jseamed/article/view/110
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Original Articles