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44 percent of postmenopausal wrist fractures had low vitamin D – Sept 2011
From American Society for Bone and Mineral Research
Hypovitaminosis D in Postmenopausal Women with a Distal Radius Fracture
Poster Sessions, Presentation Number: SU0377
Presenting Author(s): Hyun Sik Gong, Seoul National University Bundang Hospital, ROK
September 18, 2011 11:00 AM — 1:00 PM; San Diego Convention Center, Hall GH
(later presented at presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).)
Woo Young Chang, Seoul National University Bundang Hospital, South Korea; Hyun Sik Gong, Seoul National University Bundang Hospital, ROK; Cheol Ho Song, Seoul National University Bundang Hospital, South Korea
Purpose: Although hypovitaminosis D is reported to be common in the general population, few reports have examined vitamin D levels in patients with a distal radius fracture (DRF). The authors hypothesized that postmenopausal women with a DRF may have depressed vitamin D levels.
Methods: The data of 104 postmenopausal women treated for a distal radius fracture (DRF group) and 107 age-matched control patients with soft tissue disease, such as tenosynovitis or lateral epicondylitis (control group) were compared. Serum vitamin D levels (25-hydroxycholecalciferol, 25(OH)D3) and the levels of several bone metabolism markers including serum parathyroid hormone, osteocalcin, C-telopeptide, and urine N-telopeptide were sampled and compared.
Results: Mean levels of the serum 25(OH)D3 in the DRF and control groups were
- 36.38 ± 20.48 ng/mL and
- 47.16 ± 17.69 ng/mL, respectively,
and this difference was significant (p < 0.001). In particular, patients in their sixth and seventh deciles in the DRF group had significantly lower vitamin D levels than patients in the control group. Twenty-seven patients (26%) and 19 patients (18%) in the DRF group were vitamin D insufficient (defined as a serum level of 20-32ng/mL) or vitamin D deficient (defined as a serum level of < 20ng/mL), respectively, as compared with 12 patients (11%) and 2 patients (2%) in the control group (Figure 1). A weak positive correlation was found between femur neck BMD and serum 25(OH)D3 levels in the DRF group (r = 0.22, p = 0.02). However, the levels of the assessed markers of bone metabolism were similar in the two groups.
Conclusions: Postmenopausal women with a DRF were found to have significantly lower serum vitamin D levels than the control. Since vitamin D is required for bone metabolism and musculoskeletal function, further studies are warranted to determine whether hypovitaminosis D is a risk factor for DRF and whether vitamin D supplementation helps rehabilitation and the prevention of future fractures in patients with a DRF.
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Distal radius 26% 20-32 ng, 18% < 20 ng, so 44% < 30 ng
Control 11% 20-32 ng, 2% < 20 ng, so 13% < 30 ng
Distal radius fractures are among the most common osteoporosis-related fractures occurring on average 15 years earlier than hip fractures
Distal radius fracture should serve as an excellent warning to increase vitamin D level, and thus avoid most hip fractures
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Vitamin D inadequacy is associated with low-energy distal radius fractures: A case-control study
Bone. 2011 Feb 1.
Jannike Øyena, E-mail The Corresponding Author, Ellen Margrete Apalsetb, c, Clara Gram Gjesdalb, d, Christina Brudvika, e, Stein Atle Liea, f and Leiv M. Hovea, g
a Department of Surgical Sciences, University of Bergen, Bergen, Norway
b Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
c Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
d Section for Rheumatology, Institute of Medicine, University of Bergen, Bergen, Norway
e Bergen Accident and Emergency Department, Bergen, Norway
f Uni Health, Uni Research, Bergen, Norway
g Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
Received 5 October 2010; revised 24 January 2011; accepted 25 January 2011. Available online 2 February 2011.
Introduction Vitamin D inadequacy is associated with hip fractures, but the relationship has not been explored for distal radius fractures.
Aims To compare serum 25-hydroxyvitamin D (s-25(OH)D) status in low-energy distal radius fracture patients and a group of matched controls, and examine whether the observed differences in s-25(OH)D between patients and controls could be explained by differences in bone mineral density (BMD), body mass index (BMI) or smoking history.
Methods A total of 575 female and 72 male low-energy distal radius fracture patients (50–90 years) and 534 female and 52 male matched controls were included. The primary measure was levels of vitamin D. Secondary measures were BMD assessed by dual energy X-ray absorptiometry, BMI and smoking history.
Results Mean s-25(OH)D was 66.5 nmol/L in female patients and 78.7 nmol/L in controls (p < 0.001). The corresponding figures in men were 64.5 and 77.0 nmol/L (p = 0.017). In adjusted conditional logistic regression analyses, s-25(OH)D < 50 nmol/L (OR = 2.32, 95% CI: 1.47-3.64, p < 0.001), and 50–75 (OR = 1.70, 95% CI: 1.17-2.47, p = 0.005) were associated with distal radius fractures in women.
S-25(OH)D < 50 nmol/L (OR = 6.27, 95% CI: 1.17-33.66, p = 0.032) was associated with distal radius fractures in men
Conclusions Vitamin D inadequacy is associated with low-energy distal radius fractures in both women and men.
Differences in vitamin D levels are independent of BMD, BMI or smoking history.
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Women with 27 ng vitamin D got significantly more forearm fractures than women with 31 ng
Men were 6X more likely to get forearm fracture if < 20ng
A distal radius fracture is a common bone fracture of the radius in the forearm. Because of its proximity to the wrist joint, this injury is often called a wrist fracture.