The Association of Low-energy Spine Fractures and Vitamin D Inadequacy: A Case-control Study

Jaewon Lee; Wan-Sik Seo; Byung-Jik Kang; Joon-kuk Kim; Ye-Soo Park

doi:10.4184/jkss.2016.23.1.15

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Lee, Seo, Kang, Kim, and Park: The Association of Low-energy Spine Fractures and Vitamin D Inadequacy: A Case-control Study

Original Article

Journal of Korean Spine Surg 2016;23(1):15-24.

Published online: 31 March 2016

DOI: https://doi.org/10.4184/jkss.2016.23.1.15

The Association of Low-energy Spine Fractures and Vitamin D Inadequacy: A Case-control Study

Jaewon Lee, M.D., Wan-Sik Seo, M.D., Byung-Jik Kang, M.D., Joon-kuk Kim, M.D., Ye-Soo Park, M.D., Ph.D.

Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Corresponding author: Ye-Soo Park, M.D., Ph.D. Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine 153 Gyungchun-ro, Guri, Gyeonggi-do, 471-701, Korea TEL: +82-31-560-2317, FAX: +82-31-557-8781 E-mail: hyparkys@hanyang.ac.kr

Received 13 August 201518 August 2015 Accepted 29 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To compare serum vitamin D levels in elderly patients with or without osteoporotic spinal compression fractures (OSCFs) and to identify relationships between the serum vitamin D level and other variables, such as age, bone mineral density (BMD), and bone turnover markers (osteocalcin and C-telopeptide).

Summary of Literature Review

Vitamin D plays a key role in calcium metabolism in the bone tissue. Vitamin D deficiency can lead to decreased BMD and an increased risk of falls and of osteoporotic fractures.

Materials and Methods

We retrospectively reviewed the medical records of 95 elderly patients (≥60 years) with OSCFs (fracture group) and 118 subjects who had been diagnosed with osteoporosis without OSCFs (control group). Serum vitamin D levels were contrasted between the two groups taking into account other factors such as patient age, sex, and seasonal variations. For all the patients, we also evaluated the correlation between the vitamin D level and the patient age, BMD, and bone turnover markers.

Results

The mean of the serum 25(OH) vitamin D₃ levels was significantly lower in the fracture group than in the control group. There were significant differences in the 25(OH) vitamin D₃ levels in autumn. In all patients, the mean serum 25(OH) vitamin D₃ levels were the highest in autumn and the lowest in spring. Furthermore, the mean serum 25(OH) vitamin D₃ levels were significantly correlated with patient age and BMD.

Conclusions

A low serum vitamin D level might be a risk factor of OSCFs in elderly patients.

Keywords: 1,25 Dihydroxyvitamin D₃, Spinal fracture, Osteoporosis, Bone mineral density

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Fig. 1.

Diagram of included patients uture study.

Table 1.

Demographic data

		Mean		p-value
		Fracture group (N=95)	Control group (N=118)	p-value
Age (years)		73.43±6.63	71.99±7.26	0.14
Sex	Female (N/%)	83/87.4	100/84.7	0.58
Smoking (cigarette-years)		13.62±23.80	12.46±23.71	0.73
BMI (kg/m²)		24.05±3.47	24.91±3.88	0.09

p-value <0.05.

Table 2.

Mean serum 25(OH)D₃ (ng/ml) depending on age and sex

	Mean		p-value
	Fracture group	Control group	p-value
Serum 25(OH)D₃ (ng/ml)
Total	21.86±17.18	28.03±26.06	<0.05
According to age
60-69 years (N=19, 46)	24.35±22.25	29.33±25.61	0.46
70-79 years (N=60, 59)	22.34±16.27	28.73±27.69	0.13
80+ years (N=16, 13)	17.11±13.52	20.24±19.62	0.62
Sex
Male (N=12, 18)	24.48±13.25	31.97±26.95	0.08
Female (N=83, 100)	21.48±17.71	27.32±25.98	0.38

Normal range in author's hospital, Serum 25(OH)D₃ (ng/ml): 30.1–100.0.

Table 3.

Mean BMD∗ (T-score) and bone turnover markers (ng/ml)

	Mean		p-value
	Fracture group	Control group	p-value
BMD∗ (T-score)
Total	−3.83±0.80	−3.23±0.81	<0.001
L-spine	−3.65±0.95	−2.96±1.21	<0.001
Lt. hip	−2.88±0.94	−2.48±0.83	0.002
Rt. hip	−2.87±0.94	−2.49±0.88	0.003
Bone turnover markers
Osteocalcin (ng/ml)	16.72±10.68	18.18±10.89	0.33
C-telopeptide (ng/ml)	0.72±0.42	0.50±0.40	<0.001

BMD∗: bone mineral density, Normal range in author's hospital, Osteocalcin (ng/ml): men >50 years; 14-46/ post-menopause; 15-46/ pre-menopause; 11- 43, C-telopeptide (ng/ml): men 50-70 years; 0.7/ men ≥ 70 years; 0.9/ post-menopause; 1.0/ pre-menopause; 0.1–0.6.

Table 4.

Mean serum 25(OH)D₃ (ng/ml) depending on seasonal variations

	Mean		p-value
	Fracture group	Control group	p-value
Serum 25 (OH)D₃ (ng/ml)
Spring (N=23, 29)	24.37±21.97	21.82±22.94	0.7
Summer (N=19, 30)	21.68±19.69	30.26±32.87	0.26
Autumn (N=29, 32)	21.51±13.61	31.83±19.81	0.02
Winter (N=24, 27)	20.22±13.96	28.27±28.40	0.23

p-value <0.05.

Table 5.

Correlations between serum 25(OH)D₃ (ng/ml) levels and other variab

	Age	Osteocalcin	C-telopeptide	BMD	L-spine	Lt. hip	Rt. hip
r∗	−0.145	0.068	−0.077	0.206	0.209	0.215	0.188
p-value	0.034	0.32	0.27	0.003	0.003	0.002	0.007

r∗=correlation coefficient.

Table 6.

Correlations between OSCF and Serum 25(OH)D₃ (ng/ml) leve

		OSCF	serum 25(OH)D₃
OSCF	r	1	−0.335
	p		0.013
	N	213	213
	r	−0.335	1
serum 25(OH)D₃	p	0.013
	N	213	213

p-value <0.05, r∗=correlation coefficient.

Table 7.

Regression analysis between OSCF and serum 25(OH)D₃ (ng/ml) leve

		B	β	t	p	VIF
	serum 25(OH)D₃	−0.472	−0.329	−5.171	0.000	1.626
	BMI	−0.12	−0.091	−1.488	0.138	1.015
OSCF	Smoking	0.000	−0.009	−0.145	0.885	1.043
OSCF	Osteocalcin	−0.002	−0.071	−1.127	0.261	1.072
	C-telopeptide	0.016	0.343	4.505	0.000	1.585
	BMD	−0.169	−0.291	−4.585	0.000	1.100

p-value <0.05.

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