Influence of Hypovitaminosis D on the Ocurrence of Fractures^[*]

Abstract

Objective To measure the levels of vitamin D in patients hospitalized for fractures and to evaluate its relationship with fractures.

Methods A primary, analytical, cross-sectional, non-interventional, observational, controlled study was conducted in humans. The serum measurement of: vitamin D, parathyroid hormone (PTH), calcium, phosphorus, magnesium and albumin was performed in 49 patients who were consecutively hospitalized for surgery due to fracture(s) (study group), and in 50 patients without fractures, from the various outpatient clinics, and who underwent routine tests (control group).

Results The mean level of 25-hydroxyvitamin D (25[OH]D) in patients with fractures was of 23.78 ± 8.01 ng/mL (61.22% of patients with fractures had hypovitaminosis D). The mean 25(OH)D of the control group was of 37.52 ± 9.21 ng/mL (10% of the patients had hypovitaminosis D). Most cases of hypovitaminosis (96%) did not course with secondary hyperparathyroidism (mean PTH = 41.80 ± 22.75 pg/mL).

Conclusion Hypovitaminosis D was found in a significant percentage (61.22%) of the patients who suffered fractures. Further studies on the subject are needed to better understand the influence of hypovitaminosis D on the occurrence of fractures, as well as the benefits of vitamin D supplementation in these patients.

Keywords

vitamin D - vitamin D deficiency - osteoporosis - hip fractures - fracture healing

• Referências

• 1 Maeda SS, Fortes EM, Oliveira UM, Borba VC, Lazaretti-Castro M. Hypoparathyroidism and pseudohypoparathyroidism. Arq Bras Endocrinol Metabol 2006; 50 (04) 664-673
• 2 Aziziyeh R, Amin M, Habib M. et al. The burden of osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina. J Med Econ 2019; 22 (07) 638-644
• 3 Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). A importância da vitamina D na saúde da mulher. São Paulo: FEBRASGO; 2018. . (Série Orientações e Recomendações FEBRASGO, n. ^o 14)
• 4 Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc 2013; 88 (07) 720-755
• 5 Bandeira F, Griz L, Freese E. et al. Vitamin D deficiency and its relationship with bone mineral density among postmenopausal women living in the tropics. Arq Bras Endocrinol Metabol 2010; 54 (02) 227-232
• 6 Saraiva GL, Cendoroglo MS, Ramos LR. et al. Prevalência da deficiência, insuficiência de vitamina D e hiperparatiroidismo secundário em idosos institucionalizados e moradores na comunidade da cidade de São Paulo, Brasil. Arq Bras Endocrinol Metabol 2007; 51 (03) 437-442
• 7 Peters BS, dos Santos LC, Fisberg M, Wood RJ, Martini LA. Prevalence of vitamin D insufficiency in Brazilian adolescents. Ann Nutr Metab 2009; 54 (01) 15-21
• 8 Paiva CAC, Bettinelli LA, Portela MR, Pasquallotti A. Prevalência de hipovitaminose D e sua severidade em idosos institucionalizados no município de passo fundo. Rev Cont Saúde 2011; 10 (20) 1243-1250
• 9 Santos Junior EP, Fernandes DC, Almeida AT, Borges FA, Novaes JA. Epidemiologia da vitamina D. Reva Cient ITPAC, Araguaína. 2011;4(03). Disponível em: https://assets.itpac.br/arquivos/Revista/43/2.pdf
• 10 Maeda SS, Borba VVC, Camargo MB. et al. Recomendações da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) para o diagnóstico e tratamento da hipovitaminose D. Arq Bras Endocrinol Metabol 2014; 58 (05) 411-433
• 11 Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial (SBPC/ML) e Sociedade Brasileira de Endocrinologia e Metabologia, (SBEM). Posicionamento de Intervalos de Referência da Vitamina D – 25(OH)D. [acesso em 03/02/2019]. Disponível em: http://www.sbpc.org.br/noticias-e-comunicacao/novos-intervalos-de-referencia-de-vitamina-d/
• 12 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 (07) 1069-1074
• 13 Mow TC, Stokes CM, Sutherland AG. Patients presenting with fractures are likely to be vitamin D deficient: are we getting enough sun?. ANZ J Surg 2015; 85 (10) 766-769
• 14 Sprague S, Petrisor B, Scott T. et al. What is the role of vitamin d supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis D and supplementation efficacy. J Orthop Trauma 2016; 30 (02) 53-63
• 15 Gorter EA, Krijnen P, Schipper IB. Vitamin D status and adult fracture healing. J Clin Orthop Trauma 2017; 8 (01) 34-37
• 16 Devigili Jr N, Botega L, Back SRS, Stipp WN, Back Netto M. Prevalência da deficiência de vitamina D em pacientes com fraturas ocasionadas por trauma de baixa energia. Rev Bras Ortop 2019; 54 (01) 69-72
• 17 Milzman DP, Boulanger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Magnant CM. Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score. J Trauma 1992; 32 (02) 236-243 , discussion 243–244
• 18 Omeroğlu S, Erdoğan D, Omeroğlu H. Effects of single high-dose vitamin D3 on fracture healing. An ultrastructural study in healthy guinea pigs. Arch Orthop Trauma Surg 1997; 116 (1-2): 37-40
• 19 Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 2007; 21 (08) 557-570
• 20 Ettehad H, Mirbolook A, Mohammadi F, Mousavi M, Ebrahimi H, Shirangi A. Changes in the serum level of vitamin d during healing of tibial and femoral shaft fractures. Trauma Mon 2014; 19 (01) e10946
• 21 Gallagher JC. The effects of calcitriol on falls and fractures and physical performance tests. J Steroid Biochem Mol Biol 2004; 89-90 (1-5): 497-501
• 22 Pinheiro MM, Ciconelli RM, Jacques NO, Genaro PS, Martini LA, Ferraz MB. O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS). Rev Bras Reumatol 2010; 50 (02) 113-120
• 23 Mello RG, Schneider RH, Collares FM, Dalacorte RR. Vitamina D e prevenção de quedas em idosos: uma revisão sistemática. Sci Med (Porto Alegre) 2010; 20 (02) 200-206
• 24 Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med 2004; 116 (09) 634-639
• 25 Zittermann A, Gummert JF. Nonclassical vitamin D action. Nutrients 2010; 2 (04) 408-425
• 26 Weaver CM, Alexander DD, Boushey CJ. et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 2016; 27 (01) 367-376
• 27 Nino S, Soin SP, Avilucea FR. Vitamin D and Metabolic Supplementation in Orthopedic Trauma. Orthop Clin North Am 2019; 50 (02) 171-179
• 28 Bischoff-Ferrari HA, Conzelmann M, Stähelin HB. et al. Is fall prevention by vitamin D mediated by a change in postural or dynamic balance?. Osteoporos Int 2006; 17 (05) 656-663