Age and Ageing, Vol 28, 265-269, Copyright © 1999 by British Geriatrics Society
Y Sato, H Kuno, T Asoh, Y Honda and K Oizumi
OBJECTIVE: To assess the influence of immobilization upon vitamin D status
and bone mass in chronically hospitalized, disabled, elderly patients
following stroke. DESIGN: cross-sectional study. SETTING: Department of
geriatric neurology in a Japanese hospital. SUBJECTS: 129 chronically
hospitalized, disabled, elderly stroke patients and 28 age- matched
controls. RESULTS: We observed a deficiency of both 1,25- dihydroxyvitamin
D (1,25-[OH]2D; 24.3 pg/ml) and 25-hydroxyvitamin D concentrations (25-OHD;
11.7 ng/ml) in stroke patients compared with controls. A high serum ionized
calcium (mean; 2.648 mEq/l) was an independent determinant of the Barthel
index (66) and 1,25-[OH]2D. When the patients were categorized into three
groups by 25-OHD level (deficient, insufficient and sufficient), there was
no difference in the mean 1,25-[OH]2D levels. Parathyroid hormone levels
were normal or low and did not correlate with 25-OHD. Serum bone turnover
variables and bone mineral density (BMD) of the second metacarpal in
patients were significantly decreased compared to control subjects.
Independent determinants of BMD included Barthel index, 25-OHD and
1,25-[OH]2D. CONCLUSIONS: 1,25-[OH]2D deficiency in immobilized stroke
patients is not caused by substrate (25-OHD) deficiency but by
hypercalcaemia. Immobilization-induced hypercalcaemia may inhibit
parathyroid hormone secretion and thus 1,25-[OH]2D production, resulting in
decreased BMD. Immobilization itself also may be responsible for decreased
BMD. Exogenous 1,25-[OH]2D (calcitriol) rather than dietary vitamin D
supplementation may be required in disabled elderly stroke patients who
have a deficiency of 1,25-[OH]2D in order to prevent hip fractures, which
frequently occur in this population.
ARTICLES
Effect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients
Department of Neurology, Futase Social Insurance Hospital, Iizuka, Japan. y-sato@ktarn.or.jp
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