A Low Serum 25(OH) Vitamin D Level As a Risk Factor For Incidence and Severity Of Vertebral Fracture In Glucocorticoid-Induced Osteoporosis In Japan

Mari Ushikubo¹, Harumi Kuda¹, Sayaka Kubo¹, Keisuke Izumi², Kumiko Akiya¹ and Hisaji Oshima¹, ¹Department of Connective Tissue Diseases, National Tokyo Medical Center, Tokyo, Japan, ²Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Fracture risk, glucocorticoids and osteoporosis, Vitamin D

Session Information

Title: Osteoporosis and Metabolic Bone Disease: Clinical Aspects and Pathogenesis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Although levels of serum 25(OH) vitamin D (25(OH)D) have been discussed for preventing osteoporotic fractures in primary osteoporosis, an importance of the levels has not been well documented in glucocorticoid-induced osteoporosis (GIO). Also, regional differences of serum 25(OH)D levels for bone health have not been established. This study was conducted to demonstrate roles of serum 25(OH) levels for osteoporotic vertebral fractures in GIO in Japan.

Methods: A 2-year cohort study recruiting 97 patients (81 women) with collagen vascular diseases taking glucocorticoids other than rheumatoid arthritis was conducted in Tokyo, Japan. Vertebral fractures were defined from X-ray films with the semi-quantitated method (SQ, Genant 1993). Means of age, disease duration, and prednisolone dosages of subjects were 60 +/- 15 (SD), 14 +/- 12 (y), and 8.0 +/- 5.9 (mg/day), respectively. Prevalent vertebral fractures were seen in 40 patients.

Results: 1) Incident vertebral fractures were observed in 42% of the patients, and 9 patients showed more than 2 grades of the progress of fractures (DSQ≥2). 2) A mean of serum 25(OH)D levels were 18.8 +/- 6.9 pg/ml (5.9 – 36.0). Fifty five patients showed less than 20 pg/ml. 3) Patients with incident vertebral fractures showed significantly lower (p<0.04) levels of serum 25(OH)D when compared to patients with no fractures (16.9 vs 20.0 pg/ml). 4) After adjusting with known risk factors of GIO (age, predonisolone dosage, BMD, prevalent fracture, and treatments) using logistic regression analysis, a lower serum 25(OH)D level was a significant (p<0.03) risk factor (OR 1.6 / 5pg) for incident fractures. Patients with less than 20 pg/ml of serum 25(OH)D showed a significant higher rate (p<0.03, OR 1.2) of incident fractures than patients with more than 20. 5) A low level of serum 25(OH)D was also revealed as an independent risk factor (p<0.03, OR 3.1 / 5pg) for severer incident fractures (DSQ≥2).

Conclusion: It was suggested that a serum 25(OH)D level was an important factor for bone fragility in GIO in Japan.

Disclosure:

M. Ushikubo,
None;

H. Kuda,
None;

S. Kubo,
None;

K. Izumi,
None;

K. Akiya,
None;

H. Oshima,
None.

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