Document Type: RESEARCH PAPER

Authors

Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

 
Background: The main purpose of this study was to determine the relationship between serum vitamin D and the status of bone mineral density in patients with low-energy hip and distal radius fracture.
Methods: This retrospective case-control study was performed between January 2013 and January 2014. Participants aged 55 years or older were divided to case group including 85 patients with low-energy hip fracture and 83 patients with low-energy distal radius fractures, and 82 subjects as a matched control group. Bone mineral density was measured with dual energy X-ray absorptiometry and serum sample was obtained to check vitamin D, calcium, phosphorus, alkaline phosphatase, and protein.
Results: Study subjects for final evaluation consisted of 78 in hip and distal radius fracture groups and 80 in control group. There were no significant differences in the mean serum levels of calcium, phosphorus and alkaline phosphatase between the three groups. The overall mean serum level of vitamin D3 was significantly different among the three groups. Similar results were observed with hip and spine t-score between the groups.
Conclusion: There is not only a direct relation between serum vitamin D and the risk of low energy hip and distal radius fractures, but also a significant relation between low bone density in hip and spine area with low serum calcium was observed.

Keywords

Main Subjects

1. Abolhassani F, Mohammadi M, Soltani A. Burden
of osteoporosis in Iran. Iranian Journal of Public
Health. 2004. 0 (0): 18-28.
2. Keramat A, Larijani B, Adibi H, Chopra A, Kunjir V,
Patwardh B. Association between demographic factors
and osteoporosis in urban Iranian postmenopausal
women. Iranian Journal of Public Health. 2004. A
supplementary issue on Osteoporosis: 34-42
3. Cummings SR, Black D. Bone mass measurements
and risk of fracturein caucasian women: A review
of findings from prospective studies. The American
journal of medicine. 1995; 98 (2): 24S-8S.
4. Melton LJ, Atkinson EJ, O’Connor MK, O’Fallon WM,
Riggs BL. Bone density and fracture risk in men.
Journal of Bone and Mineral Research. 1998; 13
(12): 1915-23.
5. Salamat M, Rostampour N, Shanehsazzadeh S, Tavakoli
M, Siavash M, Almasi T. Assessment of bone mineral
density with dual energy X-ray absorptiometry in
pre-and post-menopausal women. Iranian Journal of
Radiation Research. 2008; 6 (2): 103-7.
6. Lips P, van Schoor NM. The effect of vitamin D on bone
and osteoporosis. Best practice & research Clinical
endocrinology & metabolism. 2011; 25 (4): 585-91.
7. Lips P. Vitamin D deficiency and secondary
hyperparathyroidism in the elderly: consequences for
bone loss and fractures and therapeutic implications.
Endocrine reviews. 2001;22(4):477-501.
8. Øyen J, Apalset EM, Gjesdal CG, Brudvik C, Lie SA,
Hove LM. Vitamin D inadequacy is associated with
low-energy distal radius fractures: a case–control
study. Bone. 2011;48(5):1140-5.
9. Labronici PJ, Blunck SS, Lana FR, Esteves BB, Franco
JS, Fukuyama JM, et al. Vitamin D and its relation to
bone mineral density in postmenopause women.
Revista Brasileira de Ortopedia. 2013;48(3):228-35.
10. Jang WY, Chung MS, Baek GH, Song CH, Cho HE,
Gong HS. Vitamin D levels in post-menopausal
Korean women with a distal radius fracture. Injury.
2012;43(2):237-41.
11. Wright S, Beringer T, Taggart H, Keegan D, Kelly
J, Whithead E, et al. A study of male patients with
forearm fracture in Northern Ireland. Clinical
rheumatology. 2007;26(2):191-5.
12. Hegeman J, Willemsen G, Van Nieuwpoort J,
Kreeftenberg H, Van Der Veer E, Slaets J, et al. Effective
tracing of osteoporosis at a fracture and osteoporosis
clinic in Groningen; an analysis of the first 100
patients. Nederlands tijdschrift voor geneeskunde.
2004;148(44):2180.
13. Owen RA, Melton LJ 3rd, Ilstrup DM, Johnson KA,
Riggs BL. Colles’ fracture and subsequent hip fracture
risk. Clin Orthop Relat Res. 1982; (171): 37-43.
14. Weiss NS, Liff JM, Ure CL, Ballard JH, Abbott GH,
Daling JR. Mortality in women following hip fracture.
Journal of chronic diseases. 1983;36(12):879-82.
15. Cooper C, Campion G, Melton Iii L. Hip fractures in
the elderly: a world-wide projection. Osteoporosis
international. 1992;2(6):285-9.
16. Cummings S, Nevitt M. Non-skeletal determinants of
fractures: the potential importance of the mechanics of
falls. Osteoporosis international. 1994;4(1):S67-S70.
17. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton III
LJ, Khaltaev N. A reference standard for the description
of osteoporosis. Bone. 2008;42(3):467-75.
18. Organization WH. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. 1994.

19. Hans D, Downs Jr RW, Duboeuf F, Greenspan S, Jankowski
LG, Kiebzak GM, et al. Skeletal sites for osteoporosis
diagnosis: the 2005 ISCD Official Positions. Journal of
Clinical Densitometry. 2006;9(1):15-21.
20. Valimaki MJ, Karkkainen M, Lambergallardk C, et
al. Exercise, smoking and calcium intake during
adolescence and early adulthood as determinants of
bone mass. BMJ 1994; 309: 230-235.
21. Karimifar M, Pasha MA, Salari A, Zamani A,
Salesi M, Motaghi P. Evaluation of bone loss in
diabetic postmenopausal women. J Res Med Sci.
2012;17(11):1033-8.
22. Fields J, Trivedi NJ, Horton E, Mechanick JI. Vitamin
D in the Persian Gulf: integrative physiology and
socioeconomic factors. Current osteoporosis reports.
2011;9(4):243-50.
23. Roddam AW, Neale R, Appleby P, Allen NE,
Tipper S, Key TJ. Association between Plasma
25-Hydroxyvitamin D Levels and Fracture Risk The
EPIC-Oxford Study. American journal of epidemiology.
2007;166(11):1327-36.
24. Woo J, Lau E, Swaminathan R, Pang C, MacDonald D.
Biochemical predictors for osteoporotic fractures in
elderly Chinese–a longitudinal study. Gerontology.
1990;36(1):55-8.
25. Cummings SR, Browner WS, Bauer D, Stone K,
Ensrud K, Jamal S, et al. Endogenous hormones
and the risk of hip and vertebral fractures among
older women. New England Journal of Medicine.
1998;339(11):733-8.
26. 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. The
Journal of Clinical Endocrinology & Metabolism.
2011;96(7):1911-30.
27. Lee JO, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS.
Age-and site-related bone mineral densities in Korean
women with a distal radius fracture compared with
the reference Korean female population. The Journal
of hand surgery. 2010;35(9):1435-41.
28. Hosseinpanah F, Rambod M, Hossein-nejad A,
Larijani B, Azizi F. Association between vitamin D
and bone mineral density in Iranian postmenopausal
women. Journal of bone and mineral metabolism.
2008;26(1):86-92.
29. Stone K, Bauer DC, Black DM, Sklarin P, Ensrud KE,
Cummings SR. Hormonal predictors of bone loss in
elderly women: a prospective study. Journal of Bone
and Mineral Research. 1998;13(7):1167-74.
30. Garnero P, Munoz F, Sornay-Rendu E, Delmas P.
Associations of vitamin D status with bone mineral
density, bone turnover, bone loss and fracture risk in
healthy postmenopausal women. The OFELY study.
Bone. 2007;40(3):716-22.
31. Allali F, El Aichaoui S, Khazani H, Benyahia B, Saoud
B, El Kabbaj S, Bahiri R, Abouqal R, Hajjaj-Hassouni
N. High prevalence of hypovitaminosis D in Morocco:
relationship to lifestyle, physical performance, bone
markers, and bone mineral density. Semin Arthritis
Rheum. 2009 Jun;38(6):444-51.
32. Rassouli A, Milanian I, Moslemi-Zadeh M.
Determination of serum 25-hydroxyvitamin D< sub>
3</sub> levels in early postmenopausal Iranian
women: relationship with bone mineral density.
Bone. 2001;29(5):428-30.
33. Rejnmark L, Lauridsen AL, Vestergaard P,
Heickendorff L, Andreasen F, Mosekilde L. Diurnal
rhythm of plasma 1, 25-dihydroxyvitamin D and
vitamin D-binding protein in postmenopausal
women: relationship to plasma parathyroid hormone
and calcium and phosphate metabolism. European
journal of endocrinology. 2002;146(5):635-42.