Hypovitaminosis D and ‘functional hypoparathyroidism’—the NoNoF (Nottingham Neck of Femur) study
Background: calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss, with an enhanced risk of osteoporotic fractures. Although hip fractures are a serious consequence, few therapeutic measures are given for primary or secondary prevention. A combination of calci...
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| Veröffentlicht in: | Age and ageing 2001-11, Vol.30 (6), p.467-472 |
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| creator | Sahota, Opinder Gaynor, Kay Harwood, Rowan H. Hosking, David J. |
| description | Background: calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss, with an enhanced risk of osteoporotic fractures. Although hip fractures are a serious consequence, few therapeutic measures are given for primary or secondary prevention. A combination of calcium and vitamin D may not be the most effective treatment for all patients. Objective: to investigate the effects of hypovitaminosis D on the calcium–parathyroid hormone endocrine axis, bone mineral density and fracture type, and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients. Design: a population‐based, prospective cohort study. Methods: 150 elderly subjects were recruited from the fast‐track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture. This ward accepts people who live at home and are independent in activities of daily living. All subjects had a baseline medical examination, biochemical tests (parathyroid hormone, 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D) and were referred for bone densitometry. Results: at 68%, the prevalence of hypovitaminosis D (25‐hydroxyvitamin D |
| doi_str_mv | 10.1093/ageing/30.6.467 |
| format | Article |
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Although hip fractures are a serious consequence, few therapeutic measures are given for primary or secondary prevention. A combination of calcium and vitamin D may not be the most effective treatment for all patients. Objective: to investigate the effects of hypovitaminosis D on the calcium–parathyroid hormone endocrine axis, bone mineral density and fracture type, and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients. Design: a population‐based, prospective cohort study. Methods: 150 elderly subjects were recruited from the fast‐track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture. This ward accepts people who live at home and are independent in activities of daily living. All subjects had a baseline medical examination, biochemical tests (parathyroid hormone, 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D) and were referred for bone densitometry. Results: at 68%, the prevalence of hypovitaminosis D (25‐hydroxyvitamin D<30 nmol/l) was high. However, only half the patients had evidence of secondary hyperparathyroidism, the rest having a low to normal level of parathyroid hormone (‘functional hypoparathyroidism’). Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium, higher 1,25‐dihydroxyvitamin D, lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ‘functional hypoparathyroid’ group (P<0.01). Conclusion: there is a high prevalence of hypovitaminosis D in active, elderly people living at home who present with a hip fracture. However, secondary hyperparathyroidism occurs in only half of these patients. This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover, leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures. Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients, but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ‘vitamin D‐replete’ subjects needs further evaluation.</description><identifier>ISSN: 0002-0729</identifier><identifier>ISSN: 1468-2834</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/30.6.467</identifier><identifier>PMID: 11742774</identifier><identifier>CODEN: AANGAH</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Aging ; Aging (Biology) ; Bone Density ; Calcium ; Calcium (Nutrient) ; Calcium - metabolism ; Calcium in the body ; Calcium supplement ; Care and treatment ; Elderly ; Elderly people ; Femur Neck - physiopathology ; Food and nutrition ; Fractured hips ; Fractures ; Health aspects ; hip fracture ; Hip fractures ; Hip Fractures - classification ; Hip Fractures - metabolism ; Hip Fractures - physiopathology ; Hip joint ; Humans ; Hypoparathyroidism - metabolism ; Hypoparathyroidism - physiopathology ; hypovitaminosis D ; Lumbar Vertebrae - physiopathology ; Older people ; Osteoporosis ; parathyroid hormone ; Parathyroid Hormone - metabolism ; Prevalence ; Prevention ; Prospective Studies ; Recurrence ; United Kingdom - epidemiology ; Vitamin D ; Vitamin D - analogs & derivatives ; Vitamin D - metabolism ; Vitamin D deficiency ; Vitamin D Deficiency - epidemiology ; Vitamin D Deficiency - metabolism ; Vitamin D Deficiency - physiopathology ; Vitamin D supplement</subject><ispartof>Age and ageing, 2001-11, Vol.30 (6), p.467-472</ispartof><rights>Copyright Oxford University Press(England) Nov 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c492t-a17b9d93fc15e98443e6d20d643f1413d4dbfe8ae06e58ac0642e3d4e6d0e37c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923,30997,30998</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11742774$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sahota, Opinder</creatorcontrib><creatorcontrib>Gaynor, Kay</creatorcontrib><creatorcontrib>Harwood, Rowan H.</creatorcontrib><creatorcontrib>Hosking, David J.</creatorcontrib><title>Hypovitaminosis D and ‘functional hypoparathyroidism’—the NoNoF (Nottingham Neck of Femur) study</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Background: calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss, with an enhanced risk of osteoporotic fractures. Although hip fractures are a serious consequence, few therapeutic measures are given for primary or secondary prevention. A combination of calcium and vitamin D may not be the most effective treatment for all patients. Objective: to investigate the effects of hypovitaminosis D on the calcium–parathyroid hormone endocrine axis, bone mineral density and fracture type, and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients. Design: a population‐based, prospective cohort study. Methods: 150 elderly subjects were recruited from the fast‐track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture. This ward accepts people who live at home and are independent in activities of daily living. All subjects had a baseline medical examination, biochemical tests (parathyroid hormone, 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D) and were referred for bone densitometry. Results: at 68%, the prevalence of hypovitaminosis D (25‐hydroxyvitamin D<30 nmol/l) was high. However, only half the patients had evidence of secondary hyperparathyroidism, the rest having a low to normal level of parathyroid hormone (‘functional hypoparathyroidism’). Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium, higher 1,25‐dihydroxyvitamin D, lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ‘functional hypoparathyroid’ group (P<0.01). Conclusion: there is a high prevalence of hypovitaminosis D in active, elderly people living at home who present with a hip fracture. However, secondary hyperparathyroidism occurs in only half of these patients. This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover, leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures. Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients, but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ‘vitamin D‐replete’ subjects needs further evaluation.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>Aging (Biology)</subject><subject>Bone Density</subject><subject>Calcium</subject><subject>Calcium (Nutrient)</subject><subject>Calcium - metabolism</subject><subject>Calcium in the body</subject><subject>Calcium supplement</subject><subject>Care and treatment</subject><subject>Elderly</subject><subject>Elderly people</subject><subject>Femur Neck - physiopathology</subject><subject>Food and nutrition</subject><subject>Fractured hips</subject><subject>Fractures</subject><subject>Health aspects</subject><subject>hip fracture</subject><subject>Hip fractures</subject><subject>Hip Fractures - classification</subject><subject>Hip Fractures - metabolism</subject><subject>Hip Fractures - physiopathology</subject><subject>Hip joint</subject><subject>Humans</subject><subject>Hypoparathyroidism - metabolism</subject><subject>Hypoparathyroidism - physiopathology</subject><subject>hypovitaminosis D</subject><subject>Lumbar Vertebrae - physiopathology</subject><subject>Older people</subject><subject>Osteoporosis</subject><subject>parathyroid hormone</subject><subject>Parathyroid Hormone - metabolism</subject><subject>Prevalence</subject><subject>Prevention</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>United Kingdom - epidemiology</subject><subject>Vitamin D</subject><subject>Vitamin D - analogs & derivatives</subject><subject>Vitamin D - metabolism</subject><subject>Vitamin D deficiency</subject><subject>Vitamin D Deficiency - epidemiology</subject><subject>Vitamin D Deficiency - metabolism</subject><subject>Vitamin D Deficiency - physiopathology</subject><subject>Vitamin D supplement</subject><issn>0002-0729</issn><issn>1468-2834</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqF0U1v0zAYB_AIgVgZnLmhiAMCibR-i50cp0JWpNFJaEhoF8t1nrTekriznWm99UNwgK_XT4JRKpC4cLJs_2w_fv5J8hKjKUYlnak1mH49o2jKp4yLR8kEM15kpKDscTJBCJEMCVKeJM-8v4lTnGPyNDnBWDAiBJskzWK3tfcmqM701huffkhVX6eH_Y9m6HUwtldtuolmq5wKm52zpja-O-x_HvbfwwbSpV3aKn27tCHESjaqS5egb1PbpBV0g3uX-jDUu-fJk0a1Hl4cx9Pka_Xxar7ILi7PP83PLjLNShIyhcWqrEvaaJxDWTBGgdcE1ZzRBjNMa1avGigUIA55oTTijEBcjQoBFZqeJm_Ge7fO3g3gg-yM19C2qgc7eCkIzTEu-H9hLkTJaC4ifP0PvLGDi13xksSSCMUoj-j9iNaqBWl6bfsAD0HbtoU1yPjF-aU8KwjhNHY-8tnItbPeO2jk1plOuZ3ESP7OVY65SooklzHXeOLVsYph1UH91x-DjCAbgfHx5T_7yt3KeFzkcvHtWl5fnS-_VGUlP9NfAx2xEg</recordid><startdate>20011101</startdate><enddate>20011101</enddate><creator>Sahota, Opinder</creator><creator>Gaynor, Kay</creator><creator>Harwood, Rowan H.</creator><creator>Hosking, David J.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20011101</creationdate><title>Hypovitaminosis D and ‘functional hypoparathyroidism’—the NoNoF (Nottingham Neck of Femur) study</title><author>Sahota, Opinder ; Gaynor, Kay ; Harwood, Rowan H. ; Hosking, David J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c492t-a17b9d93fc15e98443e6d20d643f1413d4dbfe8ae06e58ac0642e3d4e6d0e37c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aging</topic><topic>Aging (Biology)</topic><topic>Bone Density</topic><topic>Calcium</topic><topic>Calcium (Nutrient)</topic><topic>Calcium - metabolism</topic><topic>Calcium in the body</topic><topic>Calcium supplement</topic><topic>Care and treatment</topic><topic>Elderly</topic><topic>Elderly people</topic><topic>Femur Neck - physiopathology</topic><topic>Food and nutrition</topic><topic>Fractured hips</topic><topic>Fractures</topic><topic>Health aspects</topic><topic>hip fracture</topic><topic>Hip fractures</topic><topic>Hip Fractures - classification</topic><topic>Hip Fractures - metabolism</topic><topic>Hip Fractures - physiopathology</topic><topic>Hip joint</topic><topic>Humans</topic><topic>Hypoparathyroidism - metabolism</topic><topic>Hypoparathyroidism - physiopathology</topic><topic>hypovitaminosis D</topic><topic>Lumbar Vertebrae - physiopathology</topic><topic>Older people</topic><topic>Osteoporosis</topic><topic>parathyroid hormone</topic><topic>Parathyroid Hormone - metabolism</topic><topic>Prevalence</topic><topic>Prevention</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>United Kingdom - epidemiology</topic><topic>Vitamin D</topic><topic>Vitamin D - analogs & derivatives</topic><topic>Vitamin D - metabolism</topic><topic>Vitamin D deficiency</topic><topic>Vitamin D Deficiency - epidemiology</topic><topic>Vitamin D Deficiency - metabolism</topic><topic>Vitamin D Deficiency - physiopathology</topic><topic>Vitamin D supplement</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sahota, Opinder</creatorcontrib><creatorcontrib>Gaynor, Kay</creatorcontrib><creatorcontrib>Harwood, Rowan H.</creatorcontrib><creatorcontrib>Hosking, David J.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sahota, Opinder</au><au>Gaynor, Kay</au><au>Harwood, Rowan H.</au><au>Hosking, David J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypovitaminosis D and ‘functional hypoparathyroidism’—the NoNoF (Nottingham Neck of Femur) study</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2001-11-01</date><risdate>2001</risdate><volume>30</volume><issue>6</issue><spage>467</spage><epage>472</epage><pages>467-472</pages><issn>0002-0729</issn><issn>1468-2834</issn><eissn>1468-2834</eissn><coden>AANGAH</coden><abstract>Background: calcium and vitamin D deficiency are common in elderly people and lead to increased bone loss, with an enhanced risk of osteoporotic fractures. Although hip fractures are a serious consequence, few therapeutic measures are given for primary or secondary prevention. A combination of calcium and vitamin D may not be the most effective treatment for all patients. Objective: to investigate the effects of hypovitaminosis D on the calcium–parathyroid hormone endocrine axis, bone mineral density and fracture type, and the optimal role of combination calcium and vitamin D therapy after hip fracture in elderly patients. Design: a population‐based, prospective cohort study. Methods: 150 elderly subjects were recruited from the fast‐track orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture. This ward accepts people who live at home and are independent in activities of daily living. All subjects had a baseline medical examination, biochemical tests (parathyroid hormone, 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D) and were referred for bone densitometry. Results: at 68%, the prevalence of hypovitaminosis D (25‐hydroxyvitamin D<30 nmol/l) was high. However, only half the patients had evidence of secondary hyperparathyroidism, the rest having a low to normal level of parathyroid hormone (‘functional hypoparathyroidism’). Patients with secondary hyperparathyroidism and hypovitaminosis D had a higher mean corrected calcium, higher 1,25‐dihydroxyvitamin D, lower hip bone mineral density and an excess of extracapsular over intracapsular fractures than the ‘functional hypoparathyroid’ group (P<0.01). Conclusion: there is a high prevalence of hypovitaminosis D in active, elderly people living at home who present with a hip fracture. However, secondary hyperparathyroidism occurs in only half of these patients. This subgroup attempts to maintain calcium homeostasis but does so at the expense of increased bone turnover, leading to amplified hip bone loss and an excess of extracapsular over intracapsular fractures. Combination calcium and vitamin D treatment may be effective in preventing a second hip fracture in these patients, but its role in patients with hypovitaminosis D without secondary hyperparathyroidism and ‘vitamin D‐replete’ subjects needs further evaluation.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>11742774</pmid><doi>10.1093/ageing/30.6.467</doi><tpages>6</tpages></addata></record> |
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| ispartof | Age and ageing, 2001-11, Vol.30 (6), p.467-472 |
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| subjects | Aged Aged, 80 and over Aging Aging (Biology) Bone Density Calcium Calcium (Nutrient) Calcium - metabolism Calcium in the body Calcium supplement Care and treatment Elderly Elderly people Femur Neck - physiopathology Food and nutrition Fractured hips Fractures Health aspects hip fracture Hip fractures Hip Fractures - classification Hip Fractures - metabolism Hip Fractures - physiopathology Hip joint Humans Hypoparathyroidism - metabolism Hypoparathyroidism - physiopathology hypovitaminosis D Lumbar Vertebrae - physiopathology Older people Osteoporosis parathyroid hormone Parathyroid Hormone - metabolism Prevalence Prevention Prospective Studies Recurrence United Kingdom - epidemiology Vitamin D Vitamin D - analogs & derivatives Vitamin D - metabolism Vitamin D deficiency Vitamin D Deficiency - epidemiology Vitamin D Deficiency - metabolism Vitamin D Deficiency - physiopathology Vitamin D supplement |
| title | Hypovitaminosis D and ‘functional hypoparathyroidism’—the NoNoF (Nottingham Neck of Femur) study |
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