Hypovitaminosis D In Elderly Patients Presenting With Fractures
Background: Vitamin D deficiency is seen in all races, age groups and ethnic backgrounds. It is estimated to affect more than one billion people worldwide. This study was done to find out vitamin D levels and its associated factors among elderly patients presenting with fractures.
Material and method: This cross-sectional study was performed at our tertiary care hospital, in patients above 45 years, presenting with fracture as a result of trivial trauma. In all patients serum 25(OH)D level was measured. A level of serum 25(OH)D < 10 ng/ml was labeled as the deficiency, between 10 to 29 ng/ml as insufficient and ≥ 30 ng/ml as sufficient.
Results: A total of 102 patients were included in our study with mean age of 60.8 ± 13.4 years, out of which 60 were males and 42 females. Mean serum 25(OH)D level in our study population was 15.82 ± 5.88 ng/ml. We found 94.1% of the patients were having a low level of serum 25(OH)D i.e. less than 30 ng/ml, with 78.4% insufficient (between 10 to 29 ng/ml) and 15.6% deficient levels (below 10 ng/ml). Higher age, female, menopause and lack of sunlight exposure were found to be significantly associated with lower vitamin D levels.
Conclusion: This study gives us important inside of a high prevalence of hypovitaminosis D in elderly patients. Detection and prompt intervention of vitamin D deficiency at an early stage can be helpful in decreasing the fracture in these elderly.
2. Reginster JY. The high prevalence of inadequate serum vitamin D levels and implications for bone health. Curr Med Res Opin. 2005;21:579–85.
3. Harinarayan CV, Ramalakshmi T, Venkataprasad U. High prevalence of low dietary calcium and low vitamin D status in healthy south Indians. Asia-Pac J Clin Nutr. 2004;13:359–64.
4. 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.
5. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Arch Int Med. 2009;169:551.
6. Ritu G, Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutr. 2014;6:729–75.
7. Harinarayan CV, Joshi SR. Vitamin D status in India - its implications and remedial measures. J Assoc Physicians India. 2009;57:40–8.
8. Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Vitamin D status in healthy Indians aged 50 years and above. J Assoc Physician India. 2011;59:706–9.
9. Harinarayan CV, Sachan A, Reddy PA, Satish KM, Prasad U V, Srivani P. Vitamin D status and bone mineral density in women of reproductive and postmenopausal age groups: a cross-sectional study from south India. J Assoc Physicians India. 2011;59:698–704
10. Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr. 2005;81:1060–4.
11. Economist T. Comparing Indian states and territories with countries: An Indian summary. The Economist 2011. http://www.economist.com/content/indian-summary (accessed March 8, 2018).
12. Looned K, Banerjee A, Landge J, Pandit D. Intergenerational decline in Vitamin D status: A cross-sectional study among medical students and their teachers. Int J Nutr Pharmacol Neurol Dis. 2017;7:12.
13. Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86:50–60.
14. Dhanwal DK, Sahoo S, Gautam VK, Saha R. Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism. Osteoporos Int. 2013;24:553–7.
15. Paul TV, Selvan SA, Asha HS, Thomas N, Venkatesh K, Oommen AT, et al. Hypovitaminosis D and other risk factors of femoral neck fracture in South Indian postmenopausal women: a pilot study. J Clin Diagn Res 2015;9:19-22.
16. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. JAMA. 1999;281:1505–11.
17. Maier GS, Seeger JB, Horas K, Roth KE, Kurth AA, Maus U. The prevalence of vitamin D deficiency in patients with vertebral fragility fractures. Bone Joint J. 2015;97–B:89–93.
18. Simonelli C, Weiss TW, Morancey J, Swanson L, Chen YT. Prevalence of vitamin D inadequacy in a minimal trauma fracture population. Curr Med Res Opin. 2005;21:1069–74.
19. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M, Salis C, et al. Effects of Vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Mineral Res 2003;18:343–51.
20. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ (Clin Res Ed) 2003;326:469.
21. Bhat KA, Kakaji M, Awasthi A, Shukla M, Dubey M, Srivastava R, et al. High prevalence of osteoporosis and morphometric vertebral fractures in indian males aged 60 years and above: should age for screening be lowered? J Clin Densitom. 2018;21(4):517-23.
22. Arya V, Bhambri R, Godbole MM, Mithal A. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int. 2004;15:56–61.
23. Narang APS, Batra S, Sabharwal S, Ahuja SC. 1, 25-Dihydroxycholecalciferol (1,25-(OH)(2) D(3)) levels in osteoporosis. Ind J Clin Biochem 2004;19:111–3.