Clinical research on vitamin D deficiency and falls in rheumatoid arthritis patients with spinal osteoporosis fractures

Abstract

Objective To explore the effect of vitamin D deficiency and falls on osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA). Methods A total of 852 patients with RA were recruited, anteroposterior and lateral X-rays examination of vertebral column were conducted for every patient. Serum 25-hydroxy vitamin D [25(OH)D] levels and bone mineral density (BMD) of all the vertebrae of lumbar were examined. Clinical and laboratory index of patients were recorded in details meanwhile. Data of 156 normal subjects during the same period were collected as the control group. Numerical data and categorical data comparisons were analyzed using t test,χ2 test, single factor analysis of variance test, linear correlation and Logistic regression analysis test. Results ① The prevalence of vertebral OPF in RA was 16.1%(137/852). Compared to RA without OPF, patients with OPF had lower serum 25(OH)D levels [(14 ± 4) ng/ml vs (18 ± 7) ng/ml, t=2.898,P=0.004]. ② The occurrence rate of falls in RA patients was 19.7% (36/183). Patients with falls had lower serum 25(OH)D levels [(14±4) ng/ml vs (18±6) ng/ml,t=2.854,P=0.005]. ③ The prevalence of falls in RA with vertebral OPF was higher than that in RA without OPF (38.1% vs 14.2%,χ2=11.708,P=0.001). ④ Linear correlation analysis found that serum levels of 25(OH)D was positively correlated with total lumbar region BMD in RA patients. ⑤Logistic regression analysis revealed that age [OR=1.124,P=0.002, 95%CI: (1.045, 1.209)]and usage of glucocorticostroid (GC) [OR=6.724,P=0.031, 95%CI: (1.196, 37.813)] were the risk factors for occurrence of OPF in RA, while serum 25(OH) D level [OR=0.850,P=0.046, 95%CI: (0.725, 0.997)] was the protective factor. Conclusion Spinal OPF in patients with RA is clearly related with vitamin deficiency, falls and usage of GC. Key words: Osteoporotic fractures; Vitamin D; Arthritis, rheumatoid