Abstract
Both vitamin D and K2 are involved in a number of metabolic processes, including bone metabolism; however, associations between the vitamins are not fully understood. The aim of the study was to evaluate serum concentrations of 25-hydroxyvitamin D [25(OH)D] in adult patients receiving long-term acenocoumarol (AC) treatment. In this cross-sectional study, 58 Caucasian patients (31 women, 27 men) with a median age of 65 years receiving long-term AC therapy were evaluated and compared with 35 age- and gender-matched healthy controls. The AC treatment was used due to recurrent venous thromboembolism (34.5%), atrial fibrillation (31%), or mechanical heart valve prostheses (34.5%). Medical records and a questionnaire were used to obtain information about chronic diseases, smoking habits, and the duration of therapy and weekly dose of AC. Anthropometric measurements were performed, and serum concentration of 25(OH)D and total alkaline phosphatase (ALP) activity were measured. Among the 58 patients receiving long-term AC treatment, a high proportion (46.6%) demonstrated significant vitamin D deficiency with concentrations of 25(OH)D lower than 20 ng/mL. The median concentration of 25(OH)D in subjects receiving AC was significantly lower compared to the control group [20.4 (17.4; 26.1) vs. 28.2 (24; 32.7); p < 0.001]. No differences were found between women and men receiving AC therapy. In patients receiving AC, a negative correlation was found between the concentration of 25(OH)D and the weekly dose of AC (r = -0.337, p = 0.01). Patients with concentrations of 25(OH)D < 20 ng/mL were found to have a significantly higher median dose of AC, compared to those with concentrations of 25(OH)D ≥ 20 ng/mL [21 (17; 31) vs. 17 (12; 28); p = 0.045]. In conclusion, treatment with AC is associated with low 25-hydroxyvitamin D levels, although the path leading to this phenomenon is not entirely clear. Long-term administration of AC in adults may increase the risk of chronic vitamin D deficiency, thus, effective supplementation of vitamin D in these individuals needs careful consideration.
Highlights
Vitamin D synthesized in the skin or obtained from the diet is biologically inactive
No differences in terms of age, gender, body mass index (BMI), time elapsed, since menopause, smoking habits, and serum total alkaline phosphatase (ALP) activity were found between subjects receiving AC and the control group
The significantly decreased concentration of 25(OH)D observed in men and women treated with AC may indicate a potential negative effect of this therapy on vitamin D status, and presumably on bone metabolism or possible prospective health outcomes
Summary
Vitamin D synthesized in the skin or obtained from the diet is biologically inactive. Cholecalciferol [vitamin D(3)], inherently present in animals, is converted to calcifediol (25-hydroxycholecalciferol) in the liver, whereas ergocalcife rol [vitamin D(2)], naturally found in plants, is converted to 25-hydroxyergocalciferol. These two vitamin D metabolites [called 25-hydroxyvitamin D or 25(OH)D] are measured in serum to determine vitamin D status [1]. Vitamin D stimulates proliferation and differentiation of osteoblasts and osteoclasts [6], regulates the expression of numerous genes in the bone cell population [7], plays a role in the synthesis of key proteins secreted by osteoblasts, and inhibits apoptosis of osteoblasts [8]. Bone metabolism largely depends on the biological action and adequate levels of vitamin D
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