中国北方地区老年人冬季维生素D缺乏与骨量丢失

Vitamin D deficiency in winter related to bone loss of older people in northern China

背景:中国北方地区老年人维生素D营养状态存在季节变化,冬春季维生素D缺乏严重。目的:分析沈阳市老年人冬季维生素D缺乏对骨量丢失的影响。方法:随机选择沈阳市60岁以上汉族健康老年人100名,于2000-03检测受试者血浆中25羟维生素D、甲状旁腺激素、钙和磷,清晨空腹2h尿中脱氧吡啶、钙、磷、肌酐,2000-03/2005-03两次检测髋部骨密度。结果与结论:基线时,血浆25羟维生素D浓度为(31.0±12.30)nmol/L,40%受试者低于25nmol/L;血浆甲状旁腺激素水平为(29.4±11.5)ng/L,血浆25羟维生素D浓度低于25nmol/L者甲状旁腺激素水平为(34.6±13.5)ng/L,血浆25羟维生素D浓度与甲状旁腺激素呈负相关(r=-0.479,P<0.0001)。5年后股骨颈骨丢失率为(3.05±4.07)%,大转子为(1.46±5.02)%,经体质量和身高变化率校正后,股骨颈骨丢失率与基线血浆25羟维生素D浓度呈负相关(r=-2.3,P=0.02),股骨颈骨丢失率基线血浆25羟维生素D浓度≤25nmol/L者高于浓度>25nmol/L者103%(F=7.2062,P=0.0085)。其他检测指标与骨丢失无显著相关性。说明老年人群冬季维生素D缺乏严重,维生素D缺乏促进骨量丢失,影响骨健康。

BACKGROUND：There are seasonal variations in vitamin D status of older people in northern China.Vitamin D status of older people is deficient in winter and spring.OBJECTIVE：To evaluate the effect of vitamin D deficiency in winter on bone loss in elderly people in Shenyang.METHODS：100 healthy Han volunteers over 60 years old living in Shenyang were selected.Plasma 25-hydroxyvitamin D [25（OH）D],parathyroid hormone（PTH）,osteocalcin,calcium and phosphate,overnight fasting urine free deoxypyridinoline,calcium,phosphate and creatinine were analyzed in March 2000.Hip bone mineral density（BMD） was measured in March 2000 and in March 2005.RESULTS AND CONCLUSION：At baseline,mean plasma 25（OH）D concentration was（31.0±12.3） nmol/L;25（OH）D concentration of 40% of subjects was 25 nmol/L;mean PTH was（29.4±11.5） ng/L for all subjects and（34.6 ± 13.5） ng/L for the subjects with 25（OH）D concentration 25 nmol/L;plasma 25（OH）D concentration was correlated negatively with PTH concentration（r=-0.479,P 0.000 1）.After 5 years,mean bone loss rate was（3.05±4.07）% at the femoral neck and（1.46±5.02）% at the trochanter.Bone loss rate at femoral neck was negatively correlated with plasma 25（OH）D concentration at baseline（r=-2.3,P=0.02） after adjustment for weight,height and age.Bone loss rate at femoral neck for the subjects with plasma 25（OH）D concentration 25nmol/L was 103% higher than that of the subjects with plasma 25（OH）D concentrations 25 nmol/L（F=7.206 2,P=0.008 5）.No correlation was found between other markers and bone loss rate.In older populations who generally have a low vitamin D status,vitamin D deficiency is negatively contributed to their bone loss.