Does vitamin D deficiency predict tumour malignancy in patients with bone tumours? Data from a multi-center cohort analysis – Dec 2020
Journal of Bone Oncology 25 (2020) 100329. https://doi.org/10.1016/jjbo.2020.100329
Konstantin Horasa,b,, Ulrike van Herckb, Gerrit S. Maierc, Uwe Mausc,d, Norbert Harrassere,f, Franz Jakobb, Manuel Weissenbergera, Jorg Amholdta, Boris M. Holzapfela, Maximilian Ruderta
a Department of Orthopaedics, Koenig-Ludwig-Haus, University of Wuerzburg, Germany b Bernhard-Heine Centre for Musculoskeletal Research, University of Wuerzburg, Germany c Department of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg, Germany d Department of Orthopaedic and Trauma Surgery, University of Duesseldorf, Germany e Department of Orthopaedics, Klinikum rechts der Isar, TU, Munich, Germany f Excellent Center of Medicine (ECOM), Munich, Germany
Vitamin D deficiency is a global health concern that is estimated to afflict over one billion people globally. The major role of vitamin D is that of a regulator of calcium and phosphate metabolism, thus, being essential for proper bone mineralisation. Concomitantly, vitamin D is known to exert numerous extra-skeletal actions. For example, it has become evident that vitamin D has direct anti-proliferative, pro-differentiation and pro-apoptotic actions on cancer cells. Hence, vitamin D deficiency has been associated with increased cancer risk and worse prognosis in several malignancies. We have recently demonstrated that vitamin D deficiency promotes secondary cancer growth in bone. These findings were partly attributable to an increase in bone remodelling but also through direct effects of vitamin D on cancer cells. To date, very little is known about vitamin D status of patients with bone tumours in general. Thus, the objective of this study was to assess vitamin D status of patients with diverse bone tumours. Moreover, the aim was to elucidate whether or not there is an association between prediagnostic vitamin D status and tumour malignancy in patients with bone tumours.
In a multi-center analysis, 25(OH)D, PTH and calcium levels of 225 patients that presented with various bone tumours between 2017 and 2018 were assessed. Collectively, 76% of all patients had insufficient vitamin D levels with a total mean 25(OH)D level of 21.43 ng/ml (53.58 nmol/L). In particular, 52% (117/225) of patients were identified as vitamin D deficient and further 24% of patients (55/225) were vitamin D insufficient. Notably, patients diagnosed with malignant bone tumours had significantly lower 25(OH)D levels than patients diagnosed with benign bone tumours [19.3 vs. 22.75 ng/ml (48.25 vs. 56.86 nmol/L); p = 0.04).
Cancer Invest. 2017 Aug 11:1-7. doi: 10.1080/07357907.2017.1351985.
Horas K1,2, Maier G3, Jakob F2, Maus U3, Kurth A4, Jakuscheit A1, Rudert M1, Holzapfel BM1,5.
The aim of this study was to evaluate the prevalence of vitamin D deficiency in patients with different types of bone tumors and to elucidate whether or not there are differences in prediagnostic vitamin D levels in patients with malignant compared to benign bone tumors. Prediagnostic serum 25(OH)D levels of 105 consecutive patients that presented with bone tumors and tumor-like lesions to two Orthopedic Level I University Centers in Germany between 2011 and 2016 were measured on admission.
We found an alarming and widespread rate of vitamin D deficiency in patients with bone tumors. Specifically, 83% of all patients had low vitamin D levels with a mean 25(OH)D level of 19.82 ng/ml.
Notably, patients diagnosed with malignant bone tumors had significantly lower vitamin D levels compared to patients with benign bone lesions (p = 0.0008).
In conclusion, it is essential to assess vitamin D levels in patients with tumors involving bone. In addition, there might be an association between vitamin D deficiency and the onset or course of primary malignant bone tumors.
PMID: 28799812 DOI: 10.1080/07357907.2017.1351985